Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification
Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification
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DOI：
10.1093/eurheartj/ehs037
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发表时间：
2013-01-01
影响因子：
39.3
通讯作者：
Pingitore, Alessandro
中科院分区：
文献类型：
--
作者：
Di Bella, Gianluca;Siciliano, Valeria;Pingitore, Alessandro
我们试图调查心脏磁共振(CMR)获得的左心室(LV)体积、局部室壁运动异常和瘢痕组织范围是否能够改善既往心肌梗死(MI)患者的危险分层。在231名既往MI患者(年龄11岁，男性89岁)中，我们用电影CMR量化了LV体积和局部室壁运动异常，并通过晚期Gd增强(LGE)测量了心肌梗死瘢痕的范围。在随访期间(中位数为3.2年)，19名患者发生心脏事件(心脏死亡或适当的心脏内除颤器电击)。经多因素分析，调整年龄后，LGE12.7、LV舒张末容量105mL/m(2)和室壁运动积分指数1.7与不良心脏事件独立相关(P0.05，P0.001和P0.01)。无上述因素的患者和有一个或两个因素的患者发生心脏事件的风险[危险比(HR)0.112，P0.01和HR 0.261，P0.05]低于有三个因素的患者。有这三个因素的患者4年的累积事件发生率估计为29.6，有一个或两个因素的患者为7.7，无这些因素的患者为3.5。多参数CMR方法包括测量瘢痕组织范围、左室舒张末期容量和节段性室壁运动异常，改善了既往MI患者的风险分层。
We sought to investigate whether combining left ventricular (LV) volumes, regional wall motion abnormalities, and scar tissue extent obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous myocardial infarction (MI).In 231 consecutive patients (age 64 11 years, males 89) with previous MI, we quantified LV volumes and regional wall motion abnormalities by cine CMR, and measured the extent of the infarction scar by late gadolinium enhancement (LGE). During follow-up (median, 3.2 years) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 19 patients. After adjustment for age, an extent of LGE 12.7, an LV end-diastolic volume 105 mL/m(2), and a wall motion score index 1.7 were independent associated with adverse cardiac events at multivariate analysis (P 0.05, P 0.001, and P 0.01, respectively). The patients with none of these factors, and those with one or two factors, showed a lower risk of cardiac events [hazard ratio (HR) 0.112, P 0.01 and HR 0.261, P 0.05] than those with three factors. The cumulative event-rate estimated at 4 years was 29.6 in patients with all three factors, 7.7 in those with one or two factors, and 3.5 in patients with none of these factors.A multiparametric CMR approach, which includes the measure of scar tissue extent, LV end-diastolic volume and regional wall motion abnormalities, improves risk stratification of patients with previous MI.