Magnetic Resonance Imaging as a Predictor of Survival Free of Life-Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis.
Magnetic Resonance Imaging as a Predictor of Survival Free of Life-Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis.
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DOI：
10.1161/jaha.115.003040
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发表时间：
2016-05-02
影响因子：
5.4
通讯作者：
Kupari M
中科院分区：
文献类型：
--
作者：
Ekström K;Lehtonen J;Hänninen H;Kandolin R;Kivistö S;Kupari M
心脏磁共振成像在当今心脏结节病的诊断中起着关键作用。我们着手研究心脏磁共振成像是否也有助于预测心脏结节病的预后。我们的工作涉及自2004年2月以来在我院就诊的59例心脏结节病患者（38例女性，平均年龄46±10岁），并在对比增强心脏磁共振成像后进行随访。测定心肌晚期钆增强的程度（以左心室质量的百分比测量）、左心室和右心室的容积和射血分数以及基底室间隔的厚度，并分析其预后意义。截至2015年4月，23例患者达到了研究终点，包括心源性死亡（n=3）、心脏移植（n=1）和发生危及生命的室性快速性心律失常（n=19; 5例患者发生室颤，14例患者发生持续性室性心动过速）。在单变量分析中，晚期钆增强的心肌范围预测无事件生存率，基底室间隔瘢痕样变薄（<4 mm）和右心室射血分数也预测无事件生存率（均P<0.05）。在多变量考克斯回归分析中，晚期钆增强程度是心脏磁共振成像结果事件的唯一独立预测因素，风险比为2.22/三分位数（95% CI 1.07-4.59）。晚期钆增强程度>22%（第三个三分位数）对严重心脏事件的阳性和阴性预测值分别为75%和76%。心脏磁共振成像的发现和心肌晚期钆增强的程度特别有助于预测心脏结节病的严重心脏事件。
Cardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis. Our work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast‐enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life‐threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event‐free survival, as did scar‐like thinning (<4 mm) of the basal interventricular septum and the ejection fraction of the right ventricle (P<0.05 for all). In multivariate Cox regression analysis, extent of late gadolinium enhancement was the only independent predictor of outcome events on cardiac magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95% CI 1.07–4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively. Findings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis.