T1-Mapping and Outcome in Nonischemic Cardiomyopathy All-Cause Mortality and Heart Failure
T1-Mapping and Outcome in Nonischemic Cardiomyopathy All-Cause Mortality and Heart Failure
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DOI：
10.1016/j.jcmg.2015.12.001
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发表时间：
2016-01-01
影响因子：
14
通讯作者：
Nagel, Eike
中科院分区：
文献类型：
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作者：
Puntmann, Valentina O.;Carr-White, Gerry;Nagel, Eike
目的研究非缺血性扩张型心肌病(NIDCM)T1标测参数(基于T1标测方法)的预后相关性，并与传统的不良结局标记物进行比较。背景：NIDCM是临床预后不良的公认原因。NIDCM的特点是由于复杂的病理生理过程对心肌产生弥漫性影响，从而导致固有的心肌重构。弥漫性心肌病缺乏准确和非侵入性的特征，限制了对NIDCM早期心肌病的认识和有效的临床治疗。心脏磁共振(CMR)支持通过T1图检测弥漫性心肌疾病。方法这是一项前瞻性的多中心纵向研究，对637例NIDCM扩张型患者(平均年龄50岁[四分位数范围：37~76岁]；395名男性(62%))行CMR T1标测和1.5-T和3.0-T的晚期Gd增强(LGE)。主要终点是全因死亡率。结果在中位数为22个月(四分位数范围：19至25个月)的随访期内，我们共观察到28例死亡(22例心脏)和68例复合心力衰竭事件。T1标测指数(自然T1和细胞外体积分数)，以及LGE的存在和程度，可以预测全因死亡率和心衰终点(P<；0.001)。在多变量分析中，自然T1是全因和心衰复合终点的唯一独立预测因子(风险比：1.1；95%可信区间：1.0 6~1.15；风险比：1.1；95%可信区间：1.0 5~1.1；p<；两者均为0.001)，其次是包括LGE范围和右室射血分数的模型。结论通过T1图对弥漫性心肌病的无创性测量可显著预测NIDCM全因死亡率和心衰事件。我们为一种新的NIDCM风险分层算法提供了基础，该算法分别通过T1映射和LGE对弥漫性和区域性疾病进行补充评估。(J am Coll心脏ol IMG 2016；9：40-50)(C)2016，由美国心脏病学会基金会提供。
OBJECTIVES The study sought to examine prognostic relevance of T1 mapping parameters (based on a T1 mapping method) in nonischemic dilated cardiomyopathy (NIDCM) and compare them with conventional markers of adverse outcome.BACKGROUND NIDCM is a recognized cause of poor clinical outcome. NIDCM is characterized by intrinsic myocardial remodeling due to complex pathophysiological processes affecting myocardium diffusely. Lack of accurate and noninvasive characterization of diffuse myocardial disease Limits recognition of early cardiomyopathy and effective clinical management in NIDCM. Cardiac magnetic resonance (CMR) supports detection of diffuse myocardial disease by T1 mapping.METHODS This is a prospective observational multicenter Longitudinal study in 637 consecutive patients with dilated NIDCM (mean age 50 years [interquartile range: 37 to 76 years]; 395 males [62%]) undergoing CMR with T1 mapping and Late gadolinium enhancement (LGE) at 1.5-T and 3.0-T. The primary endpoint was all-cause mortality. A composite of heart failure (HF) mortality and hospitalization was a secondary endpoint.RESULTS During a median follow-up period of 22 months (interquartile range: 19 to 25 months), we observed a total of 28 deaths (22 cardiac) and 68 composite HF events. T1 mapping indices (native T1 and extracellular volume fraction), as well as the presence and extent of LGE, were predictive of all-cause mortality and HF endpoint (p < 0.001 for all). In multivariable analyses, native T1 was the sole independent predictor of all-cause and HF composite endpoints (hazard ratio: 1.1; 95% confidence interval: 1.06 to 1.15; hazard ratio: 1.1; 95% confidence interval: 1.05 to 1.1; p < 0.001 for both), followed by the models including the extent of LGE and right ventricular ejection fraction, respectively.CONCLUSIONS Noninvasive measures of diffuse myocardial disease by T1 mapping are significantly predictive of all-cause mortality and HF events in NIDCM. We provide a basis for a novel algorithm of risk stratification in NIDCM using a complementary assessment of diffuse and regional disease by T1 mapping and LGE, respectively. (J Am Coll Cardiol Img 2016;9:40-50) (C) 2016 by the American College of Cardiology Foundation.