Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy
Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy
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DOI：
10.1016/j.jacc.2006.07.049
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发表时间：
2006-11-21
影响因子：
24
通讯作者：
Pennell, Dudley J.
中科院分区：
文献类型：
--
作者：
Assomull, Ravi G.;Prasad, Sanjay K.;Pennell, Dudley J.
目的我们在一项前瞻性纵向研究中研究了扩张型心肌病（DCM）中壁纤维化的预后影响。背景在设备植入时代，非缺血性扩张型心肌病患者的风险分层是有问题的。晚期钆增强（LGE）心血管磁共振（CMR）检测到约30%的DCM患者具有中壁纤维化，方法前瞻性随访101例有或无中壁纤维化的连续性DCM患者658 +/-结果35%的患者存在中壁纤维化，并且与预定义的主要联合终点（全因死亡和因心血管事件住院）的较高发生率相关（危害比3.4，p = 0.01）。多变量分析显示，中壁纤维化是死亡或住院的唯一显著预测因素。然而，两组之间的全因死亡率无显著差异。中壁纤维化还可预测心源性猝死（SCD）或室性心动过速（VT）的次要结局指标（风险比5.2，p = 0.03）。校正两组间左心室射血分数的基线差异后，中壁纤维化仍然是SCD/VT的预测指标。结论：在DCM中，CMR测定的中壁纤维化是全因死亡率和心血管住院的联合终点的预测指标，它独立于心室重构。此外，CMR显示的中壁纤维化可预测SCD/VT。这表明CMR在DCM患者风险分层中的潜在作用，这可能在确定是否需要器械治疗方面具有价值。
OBJECTIVES We studied the prognostic implications of midwall fibrosis in dilated cardiomyopathy (DCM) in a prospective longitudinal study.BACKGROUND Risk stratification of patients with nonischemic DCM in the era of device implantation is problematic. Approximately 30% of patients with DCM have midwall fibrosis as detected by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR), which may increase susceptibility to arrhythmia and progression of heart failure.METHODS Consecutive DCM patients (n = 101) with the presence or absence of midwall fibrosis were followed up prospectively for 658 +/- 355 days for events.RESULTS Midwall fibrosis was present in 35% of patients and was associated with a higher rate of the predefined primary combined end point of all-cause death and hospitalization for a cardiovascular event (hazard ratio 3.4, p = 0.01). Multivariate analysis showed midwall fibrosis as the sole significant predictor of death or hospitalization. However, there was no significant diffierence in all-cause mortality between the 2 groups. Midwall fibrosis also predicted secondary outcome measures of sudden cardiac death (SCD) or ventricular tachycardia (VT) (hazard ratio 5.2, p = 0.03). Midwall fibrosis remained predictive of SCD/VT after correction for baseline differences in left ventricular ejection fraction between the 2 groups.CONCLUSIONS In DCM, midwall fibrosis determined by CMR is a predictor of the combined end point of all-cause mortality and cardiovascular hospitalization, which is independent of ventricular remodeling. In addition, midwall fibrosis by CMR predicts SCD/VT. This suggests a potential role for CMR in the risk stratification of patients with DCM, which may have value in determining the need for device therapy.