Myocardial Damage Detected by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Is Associated With Subsequent Hospitalization for Heart Failure
Myocardial Damage Detected by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Is Associated With Subsequent Hospitalization for Heart Failure
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DOI：
10.1161/jaha.113.000416
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发表时间：
2013-12-01
影响因子：
5.4
通讯作者：
Schelbert, Erik B.
中科院分区：
文献类型：
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作者：
Wong, Timothy C.;Piehler, Kayla M.;Schelbert, Erik B.
背景-心力衰竭住院治疗是医学面临的最重要的问题之一。晚期钆增强（LGE）心血管磁共振（CMR）可有力地识别内在心肌损伤。LGE可能表明HHF的固有脆弱性，无论病因，在整个频谱的心力衰竭阶段或左心室射血分数（LVEF）。方法和结果-我们纳入了1068例连续的CMR患者，其中448（42%）表现出LGE。在中位数1.4年（Q1至Q3：0.9至2.0年）后，发生了57起HHF事件，15例死亡发生在HHF后，43例死亡发生在没有既往HHF的情况下（共58例死亡）。使用校正LVEF、心力衰竭分期和其他协变量的多变量考克斯回归，LGE与CMR后首次HHF（HR：2.70，95% CI：1.32 - 5.50）、死亡（HR：2.13，95% CI：1.08 - 4.21）或死亡或HHF（HR：2.52，95% CI：1.49 - 4.25）相关。量化LGE程度得出了类似的结果;更多的LGE等同于更高的风险。LGE改善了模型区分度（IDI：0.016，95% CI：0.005至0.028，P=0.002）和风险个体的重新分类（连续NRI：0.40，95% CI：0.05至0.70，P=0.024）。调整与HHF有共同危险因素的死亡竞争风险，加强了LGE和HHF的关联（HR：4.85，95%CI：1.40至16.9）。结论：LGE的存在和程度与HHF的易感性相关，包括心力衰竭阶段和LVEF范围内的HHF风险较高。即使LVEF严重降低，无LGE的患者也表现良好。LGE可以增强HHF的风险分层，并可以增强临床和研究工作，以通过靶向治疗减少HHF。
Background-Hospitalization for heart failure (HHF) is among the most important problems confronting medicine. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) robustly identifies intrinsic myocardial damage. LGE may indicate inherent vulnerability to HHF, regardless of etiology, across the spectrum of heart failure stage or left ventricular ejection fraction (LVEF).Methods and Results-We enrolled 1068 consecutive patients referred for CMR where 448 (42%) exhibited LGE. After a median of 1.4 years (Q1 to Q3: 0.9 to 2.0 years), 57 HHF events occurred, 15 deaths followed HHF, and 43 deaths occurred without antecedent HHF (58 total deaths). Using multivariable Cox regression adjusting for LVEF, heart failure stage, and other covariates, LGE was associated with first HHF after CMR (HR: 2.70, 95% CI: 1.32 to 5.50), death (HR: 2.13, 95% CI: 1.08 to 4.21), or either death or HHF (HR: 2.52, 95% CI: 1.49 to 4.25). Quantifying LGE extent yielded similar results; more LGE equated higher risks. LGE improved model discrimination (IDI: 0.016, 95% CI: 0.005 to 0.028, P=0.002) and reclassification of individuals at risk (continuous NRI: 0.40, 95% CI: 0.05 to 0.70, P=0.024). Adjustment for competing risks of death that shares common risk factors with HHF strengthened the LGE and HHF association (HR: 4.85, 95% CI: 1.40 to 16.9).Conclusions-The presence and extent of LGE is associated with vulnerability for HHF, including higher risks of HHF across the spectrum of heart failure stage and LVEF. Even when LVEF is severely decreased, those without LGE appear to fare reasonably well. LGE may enhance risk stratification for HHF and may enhance both clinical and research efforts to reduce HHF through targeted treatment.