Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy
Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy
复制标题
DOI：
10.3390/jcm9061997
复制
发表时间：
2020-06-01
影响因子：
3.9
通讯作者：
Agoston-Coldea, Lucia
中科院分区：
文献类型：
--
作者：
Cojan-Minzat, Bianca Olivia;Zlibut, Alexandru;Agoston-Coldea, Lucia
为研究心脏磁共振成像（cMRI）晚期钆增强（LGE）证实的非缺血性扩张型心肌病（NIDCM）和心肌替代纤维化患者左心室（LV）长轴应变（LAS）和左心室球形指数（LVSI）与预后的关系，我们对178例患者进行了前瞻性研究（48 +/- 14.4岁; 25.2%女性）首次诊断为NIDCM。评价方案包括ECG监测、超声心动图和cMRI。通过cMRI测定LAS和LVSI。主要不良心血管事件（MACE）定义为包括心力衰竭（HF）、室性心律失常（VA）和心源性猝死（SCD）在内的复合结局。在中位随访17个月后，LGE+患者发生MACE的风险增加。Kaplan-Meier曲线显示，LGE+患者的MACE发生率显著较高（p< 0.001），LVSI增加（p< 0.01），LAS降低（p< 0.001）。在考克斯分析中，LAS（HR = 1.32，95%CI（1.54-9.14），p= 0.001）、LVSI [HR = 1.17，95%CI（1.45-7.19），p< 0.01]和LGE+（HR = 1.77，95%CI（2.79-12.51），p< 0.0001）是MACE的独立预测因子。在基于LV射血分数（LVEF）<30%，LGE+，LAS > -7.8%和LVSI > 0.48%的4分风险评分系统中，3分和4分的患者发生MACE的风险显著较高。LAS和LVSI是MACE的独立预测因子，并在NIDCM和心肌纤维化患者中提供超过LVEF和LGE+的增量值。
To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 +/- 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p< 0.001), increased LVSI (p< 0.01) and decreased LAS (p< 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54-9.14),p= 0.001), LVSI [HR = 1.17, 95%CI (1.45-7.19),p< 0.01] and LGE+ (HR = 1.77, 95%CI (2.79-12.51),p< 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > -7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.