Response by Halliday et al to Letter Regarding Article, "Association Between Midwall Late Gadolinium Enhancement and Sudden Cardiac Death in Patients with Dilated Cardiomyopathy and Mild and Moderate Left Ventricular Systolic Dysfunction".
Response by Halliday et al to Letter Regarding Article, "Association Between Midwall Late Gadolinium Enhancement and Sudden Cardiac Death in Patients with Dilated Cardiomyopathy and Mild and Moderate Left Ventricular Systolic Dysfunction".
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Halliday 等人对有关文章“扩张型心肌病和轻度和中度左心室收缩功能障碍患者中壁晚期钆增强与心脏猝死之间的关联”的信件的回应。
DOI：
10.1161/circulationaha.117.032053
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发表时间：
2018
期刊：
影响因子：
37.8
通讯作者：
Halliday BP
中科院分区：
文献类型：
--
作者：
Halliday BP
我们感谢Locorotondo博士及其同事对我们最近发表的文章的友好评论。1我们同意，尽管扩张型心肌病中的中壁晚期钆增强（LGE）的量化已被证明在同一中心的操作者之间使用单一技术是可重复的，但尚不清楚当使用不同技术检查不同中心的操作者时是否仍然如此。2 LGE的定量依赖于一定程度的主观解释，这似乎是在临床实践中使用临界值的主要障碍。此外，扩张型心肌病患者LGE程度与特定结局之间的确切关系仍不确定。使用比例风险模型检查LGE程度和结果之间的关联假设线性剂量依赖关系，目前尚不清楚这是否真的存在。LGE的位置和模式与结果之间的关联是另一个重要的评估领域。根据现有证据，我们预测不良风险的首选方法是考虑中壁LGE的存在或不存在，而不是考虑程度。Locorotondo博士还强调了T1和细胞外容积图在检测弥漫性间质纤维化方面的潜力。Nakamori及其同事4最近提供了扩张型心肌病中天然T1和细胞外容积映射与胶原体积分数之间的重要组织学相关性。虽然替代心肌纤维化被认为在引发和维持折返性室性心动过速中起重要作用，但间质纤维化可能有助于局灶性机制引起的心动过速。因此，T1和细胞外容积图可能在预测不良脑血管事件中具有合理的作用。然而，无论是将增加增量价值LGE的预测心脏性猝死是不确定的。在我们的研究中，在中位随访4.6年期间，无LGE患者的事件发生率仅为2.3%。1无LGE的扩张型心肌病患者和健康对照组的天然T1值也存在显著重叠。5还需要解决使用不同扫描仪和造影剂引起的T1值变化。
We thank Dr Locorotondo and colleagues for their kind comments regarding our recently published article. 1 We agree that, although the quantification of midwall late gadolinium enhancement (LGE) in dilated cardiomyopathy has been shown to be reproducible between operators in the same center using a single technique, it is not known whether this remains the case when examining operators in different centers using different techniques. 2 Quantification of LGE relies on a degree of subjective interpretation, and this appears to be a major barrier to the use of cutoff values within clinical practice. In addition, the exact relationship between the extent of LGE and specific outcomes in patients with dilated cardiomyopathy remains uncertain. Examining the association between LGE extent and outcome using proportional hazard modeling assumes a linear dose-dependent relationship, and whether this truly exists is currently unclear. The association between the location and pattern of LGE and outcome is another important area for evaluation. Based on available evidence, our preferred approach to predicting adverse risk is one considering the binary presence or absence of midwall LGE rather than one taking into account the extent. 3Dr Locorotondo also importantly highlights the potential of T1and extracellular volume mapping for the detection of diffuse interstitial fibrosis. Nakamori and colleagues 4 have recently provided an important histological correlation between native T1 and extracellular volume mapping and collagen volume fraction in dilated cardiomyopathy. Although replacement myocardial fibrosis is thought to play a prominent role in initiating and sustaining reentrant ventricular tachycardia, it is possible that interstitial fibrosis may contribute to tachycardias arising from focal mechanisms. T1 and extracellular volume mapping may therefore have a plausible role in the prediction of adverse arrhythmic events. However, whether either will add incremental value to LGE for the prediction of sudden cardiac death is uncertain. In our study, the event rate in patients without LGE was only 2.3% over a median follow-up of 4.6 years. 1 Significant overlap in native T1 values also exists in patients with dilated cardiomyopathy without LGE and healthy controls. 5 Variation in T1 values arising from the use of different scanners and contrast agents also needs to be addressed.
影响因子：
14
作者：
Neilan, Tomas G.;Coelho-Filho, Otavio R.;Danik, Stephan B.;Shah, Ravi V.;Dodson, John A.;Verdini, Daniel J.;Tokuda, Michifumi;Daly, Caroline A.;Tedrow, Usha B.;Stevenson, William G.;Jerosch-Herold, Michael;Ghoshhajra, Brian B.;Kwong, Raymond Y.
通讯作者：
Kwong, Raymond Y.