The Prognostic Value of Left Ventricular Mechanical Dyssynchrony Derived from Cardiac MRI in Patients with Idiopathic Dilated Cardiomyopathy
The Prognostic Value of Left Ventricular Mechanical Dyssynchrony Derived from Cardiac MRI in Patients with Idiopathic Dilated Cardiomyopathy
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DOI：
10.1148/ryct.2021200536
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发表时间：
2021-08-01
期刊：
影响因子：
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通讯作者：
Chen, Yucheng
中科院分区：
文献类型：
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作者：
Li, Yangjie;Liu, Xiumin;Chen, Yucheng
目的：目的：探讨应用形变配准算法（deformable registration algorithm，CMR）分析原发性扩张型心肌病（idiopathic dilated cardiomyopathy，DCM）患者心脏MRI（cardiac MRI，CMR）机械运动不同步性的预后价值。（临床试验编号ChiCTR 1800017058）入组了409例特发性DCM患者（平均年龄48岁6 14; 300例男性），这些患者在2012年6月至2018年9月期间接受了CMR。机械不同步性测量为标准偏差的时间峰值（sdTTP）和均匀性比估计（URE）指数通过应变分析。主要终点包括全因死亡率和心脏移植。次要终点包括主要终点、流产的心源性猝死和心力衰竭再入院。考克斯回归分析和Kaplan-Meier生存分析，以确定变量和outcomes.Results之间的关联：在中位随访25.1个月，57和132例患者达到主要和次要终点，分别。达到主要终点的患者的大多数URE指数显著降低。在多变量分析中，心尖水平的环周URE（CURE）与主要终点（风险比，0.307 [95% CI：0.106，0.883]; P = 0.03）和次要终点（风险比，0.452 [95% CI：0.209，0.979]; P = 0.04）独立相关，而大多数sdTTP指标则不相关。此外，在左心室射血分数小于35%或存在晚期钆增强的患者中，在心尖水平小于0.917的CURE具有显着较高的不良outcomes.Conclusion率：与sdTTP测量相比，URE指数更能预测预后结果;心尖水平的CURE是DCM患者不良心脏事件的独立预测因子。
Purpose: To investigate the prognostic value of mechanical dyssynchrony evaluated by deformable registration algorithm (DRA) analysis of cardiac MRI (CMR) in patients with idiopathic dilated cardiomyopathy (DCM).Materials and Methods: This secondary analysis of a prospective study (clinical trial no. ChiCTR1800017058) enrolled 409 patients (mean age, 48 years 6 14; 300 men) with idiopathic DCM who underwent CMR between June 2012 and September 2018. Mechanical dyssynchrony was measured as standard deviation of time-to-peak (sdTTP) and uniformity ratio estimate (URE) indexes by DRA strain analysis. The primary endpoint included all-cause mortality and heart transplantation. The secondary endpoint included primary endpoint, aborted sudden cardiac death, and heart failure readmission. Cox regression analyses and Kaplan-Meier survival analysis were performed to identify the association between variables and outcomes.Results: During a median follow-up of 25.1 months, 57 and 132 patients reached primary and secondary endpoints, respectively. Most URE indexes were significantly lower in patients reaching primary endpoint. In multivariable analysis, circumferential URE (CURE) at apical level was independently associated with primary endpoints (hazard ratio, 0.307 [95% CI: 0.106, 0.883]; P =.03) and secondary endpoints (hazard ratio, 0.452 [95% CI: 0.209, 0.979]; P =.04), whereas most sdTTP measures were not. Furthermore, among patients with left ventricular ejection fraction of less than 35% or presence of late gadolinium enhancement, those with CURE at apical level of less than 0.917 had a significantly higher rate of adverse outcomes.Conclusion: URE indexes were more predictive of prognostic outcomes compared with sdTTP measurements; the CURE at apical level was an independent predictor of adverse cardiac events in patients with DCM.