Predictors of left ventricular remodelling in patients with dilated cardiomyopathy - a cardiovascular magnetic resonance study
Predictors of left ventricular remodelling in patients with dilated cardiomyopathy - a cardiovascular magnetic resonance study
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DOI：
10.1002/ejhf.1734
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发表时间：
2020-02-13
影响因子：
18.2
通讯作者：
Prasad, Sanjay K.
中科院分区：
文献类型：
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作者：
Tayal, Upasana;Wage, Ricardo;Prasad, Sanjay K.
目的需要更好的生物标志物来预测扩张型心肌病(DCM)的左心室重构。我们对心脏结构和心肌成分进行了全面的评估，以确定重构的预测因素。方法和结果对新近发病的DCM患者进行前瞻性研究，通过心血管磁共振(CMR)评估心脏结构和功能、细胞外容量(T1图)、心肌应变、心肌瘢痕(晚期Gd增强)和收缩储备(多巴酚丁胺负荷)。回归分析用于评估12个月后左室射血分数(LVEF)变化的预测因素。我们评估了56名参与者(34名DCM患者，中位数LVEF为43%；22名对照组)。LV绝对收缩储备预测LVEF的变化(12个月时1%的增加与0.4%的增加相关，P=0.02)。基础心肌应变(P=0.39)、间质心肌纤维化(P=0.41)、替换性心肌纤维化(P=0.25)和右室收缩储备(P=0.17)与LV反向重构无关。收缩储备与LV细胞外体积分数(r=-0.22，P=0.23)或基础LVEF值(r=0.07，P=0.62)的相关性较差。男性更有可能经历不良的左心室重构(P=0.01)，但年龄(P=0.88)和改善疾病的心力衰竭药物(β-受体阻滞剂，P=0.28；血管紧张素转换酶抑制剂，P=0.92)并不能预测随访的LVEF。结论大多数新发DCM患者的左心室功能在12个月内基本恢复。女性的左心室射血分数改善最大。多巴酚丁胺负荷CMR测量的低左室收缩储备似乎可以确定其左心室射血分数不太可能恢复的患者。
Aims There is an important need for better biomarkers to predict left ventricular (LV) remodelling in dilated cardiomyopathy (DCM). We undertook a comprehensive assessment of cardiac structure and myocardial composition to determine predictors of remodelling.Methods and results Prospective study of patients with recent-onset DCM with cardiovascular magnetic resonance (CMR) assessment of ventricular structure and function, extracellular volume (T1 mapping), myocardial strain, myocardial scar (late gadolinium enhancement) and contractile reserve (dobutamine stress). Regression analyses were used to evaluate predictors of change in LV ejection fraction (LVEF) over 12 months. We evaluated 56 participants (34 DCM patients, median LVEF 43%; 22 controls). Absolute LV contractile reserve predicted change in LVEF (1% increase associated with 0.4% increase in LVEF at 12 months, P = 0.02). Baseline myocardial strain (P = 0.39 global longitudinal strain), interstitial myocardial fibrosis (P = 0.41), replacement myocardial fibrosis (P = 0.25), and right ventricular contractile reserve (P = 0.17) were not associated with LV reverse remodelling. There was a poor correlation between contractile reserve and either LV extracellular volume fraction (r = -0.22, P = 0.23) or baseline LVEF (r = 0.07, P = 0.62). Men were more likely to experience adverse LV remodelling (P = 0.01) but age (P = 0.88) and disease-modifying heart failure medication (beta-blocker, P = 0.28; angiotensin-converting enzyme inhibitor, P = 0.92) did not predict follow-up LVEF.Conclusions Substantial recovery of LV function occurs within 12 months in most patients with recent-onset DCM. Women had the greatest improvement in LVEF. A low LV contractile reserve measured by dobutamine stress CMR appears to identify patients whose LVEF is less likely to recover.