Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy
Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy
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DOI：
10.1136/heartjnl-2016-309746
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发表时间：
2017-05-01
期刊：
影响因子：
5.7
通讯作者：
Kawai, Hiroya
中科院分区：
文献类型：
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作者：
Chimura, Misato;Onishi, Tetsuari;Kawai, Hiroya
目的心脏磁共振(CMR)成像的晚期Gd增强(LGE)与不良预后相关，然而，很少有研究讨论二维斑点追踪(2DST)超声心动图中由整体纵向应变(GLS)指示的左心室(LV)变形参数对非缺血性扩张型心肌病(DCM)患者预后的价值。方法连续179例有症状的DCM患者(年龄61±15岁；男性121例；左心室射血分数(LVEF)33%+/-9%；纽约心脏协会(NYHA)II级71例，III级107例，IV级1例)接受了CMR和超声心动图常规评估和2DST分析。结果在3.8+/2.5年的随访期内，有40例因心力衰竭再住院，其中7例死亡，2例植入LV辅助装置。单因素COX比例风险回归分析显示，NYHA分级、血压、B型利钠肽、LV舒张末和收缩末期容量、LVEF、左房容量、GLS和LGE与远期预后显著相关。多变量分析显示GLS和LGE与长期预后独立相关(P
Objective Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging has been reported to be associated with unfavourable outcomes; however, few studies have addressed the prognostic value of left ventricular (LV) deformation parameter indicated by global longitudinal strain (GLS) in two-dimensional speckle-tracking (2DST) echocardiography in patients with non-ischaemic dilated cardiomyopathy (DCM). This study aims to investigate whether the combination of GLS and LGE is useful in stratifying the risk in patients with DCM.Methods We studied 179 consecutive symptomatic patients with DCM (age, 61 +/- 15 years; 121 males; left ventricular ejection fraction (LVEF) 33% +/- 9%; New York Heart Association (NYHA) class II: n=71, III: n=107, IV: n=1) who underwent CMR and echocardiography with conventional assessment and 2DST analysis.Results There were 40 rehospitalisations for heart failure, including 7 cardiac deaths and 2 implantations of LV assist device during follow-up (3.8 +/- 2.5 years). Univariable Cox proportional hazard regression analysis showed that NYHA class, blood pressure, B-type natriuretic peptide, LV end-diastolic and end-systolic volumes, LVEF, left atrium volume, GLS and LGE were significantly associated with long-term outcome. Multivariable analysis revealed that GLS and LGE were independently associated with long-term outcome (p