Prognostic Value of Routine Cardiac Magnetic Resonance Assessment of Left Ventricular Ejection Fraction and Myocardial Damage An International, Multicenter Study
Prognostic Value of Routine Cardiac Magnetic Resonance Assessment of Left Ventricular Ejection Fraction and Myocardial Damage An International, Multicenter Study
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DOI：
10.1161/circimaging.111.964965
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发表时间：
2011-11-01
影响因子：
7.5
通讯作者：
Kim, Raymond J.
中科院分区：
文献类型：
--
作者：
Klem, Igor;Shah, Dipan J.;Kim, Raymond J.
背景：心脏磁共振（CMR）被认为是评估左心室射血分数（LVEF）和心肌损伤的参考标准。然而，很少有研究评估CMR结果与患者预后之间的关系，其中大多数是小型且非多中心的研究。我们进行了一项国际、多中心研究，以评估常规CMR对已知或疑似心脏病患者预后的重要性。方法和结果：来自6个国家的10个中心，分别通过电影和延迟增强成像（DE-CMR）对连续接受常规CMR评估LVEF和心肌损伤的患者进行筛选。在所有站点收集临床数据、CMR方案信息和结果，并提交给数据协调中心进行完整性验证和分析。主要终点为全因死亡率。共入组1560例患者（年龄59±14岁，70%为男性）。平均LVEF为45 +/- 18%，1049例（67%）患者在DE-CMR上显示组织高增强（HE），表明损伤。在中位随访时间为2.4年（四分位数范围为1.2年至2.9年）期间，176例（11.3%）患者死亡。死亡患者年龄较大（P < 0.0001）、有冠心病（P = 0.004）、LVEF较低（P < 0.0001）、HE节段较多（P < 0.0001）。在多变量分析中，年龄、LVEF和HE节段数是死亡率的独立预测因子。在接近正常LVEF（>= 50%）的患者中，高于中位HE（>4段）的患者与低于或处于中位HE的患者相比，生存率降低（P = 0.02）。结论：常规CMR评估的LVEF和心肌损伤量是全因死亡率的独立预测因子。即使在LVEF接近正常的患者中，严重的损伤也会导致早期死亡的高风险。（中国心血管杂志，2011;4:610-619）
Background-Cardiac magnetic resonance (CMR) is considered the reference standard for assessment of left ventricular ejection fraction (LVEF) and myocardial damage. However, few studies have evaluated the relationship between CMR findings and patient outcome, and of these, most are small and none multicenter. We performed an international, multicenter study to assess the prognostic importance of routine CMR in patients with known or suspected heart disease.Methods and Results-From 10 centers in 6 countries, consecutive patients undergoing routine CMR assessment of LVEF and myocardial damage by cine and delayed-enhancement imaging (DE-CMR), respectively, were screened for enrollment. Clinical data, CMR protocol information, and findings were collected at all sites and submitted to the data coordinating center for verification of completeness and analysis. The primary end point was all-cause mortality. A total of 1560 patients (age, 59 +/- 14 years; 70% men) were enrolled. Mean LVEF was 45 +/- 18%, and 1049 (67%) patients had hyperenhanced tissue (HE) on DE-CMR indicative of damage. During a median follow-up time of 2.4 years (interquartile range, 1.2, 2.9 years), 176 (11.3%) patients died. Patients who died were more likely to be older (P < 0.0001), have coronary disease (P = 0.004), have lower LVEF (P < 0.0001), and have more segments with HE (P < 0.0001). In multivariable analysis, age, LVEF, and number of segments with HE were independent predictors of mortality. Among patients with near-normal LVEF (>= 50%), those with above-median HE (>4 segments) had reduced survival compared to patients with below-or at-median HE (P = 0.02).Conclusions-Both LVEF and amount of myocardial damage as assessed by routine CMR are independent predictors of all-cause mortality. Even in patients with near-normal LVEF, significant damage identifies a cohort with a high risk for early mortality. (Circ Cardiovasc Imaging. 2011;4:610-619.)