Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function ITAMY Study
Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function ITAMY Study
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DOI：
10.1016/j.jacc.2017.08.044
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发表时间：
2017-10-17
影响因子：
24
通讯作者：
Di Bella, Gianluca
中科院分区：
文献类型：
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作者：
Aquaro, Giovanni Donato;Perfetti, Matteo;Di Bella, Gianluca
背景心脏磁共振（CMR）和晚期钆增强（LGE）在左室射血分数（EF）保留的急性心肌炎（AM）中的预后作用尚不明确。结论本研究旨在评价CMR和LGE在左室射血分数（EF）保留的AM预后中的作用。（意大利关于急性心肌炎的多中心研究），并评价了386例AM和LVEF保留患者（299例男性;平均年龄35 ± 15岁）的CMR结果。临床随访的中位数为1，572天。结果在374例影像符合要求的患者中，154例LGE累及心外膜下壁和侧壁，154例LGE累及心外膜下壁和侧壁（41%; IL组），135例患者的前间壁中壁层（36%; AS [前间隔]组），其他节段59例（16%;其他LGE组），26例患者（无LGE组）不存在。AS组的LGE程度更大，LV舒张末期容积指数更高，但炎症标志物水平低于其他组。Kaplan-Meier曲线分析显示AS组预后明显差于其他各组（p < 0.0001）。最后，在多变量分析中，AS LGE是联合终点的最佳独立CMR预测因子（比值比：2.73; 95%置信区间：1.2至5.9; p = 0.01）。结论：在AM和LVEF保留的患者中，AS心肌段中壁层的LGE与比其他表现模式更差的预后相关。(C)2017年由美国心脏病学会基金会。
BACKGROUND The prognostic role of cardiac magnetic resonance (CMR) and late gadolinium enhancement (LGE) has not been clarified in acute myocarditis (AM) with preserved left ventricular (LV) ejection fraction (EF).OBJECTIVES This study sought to evaluate the role of CMR and LGE in the prognosis of AM with preserved LVEF.METHODS This study analyzed data from ITAMY (ITalian multicenter study on Acute MYocarditis) and evaluated CMR results from 386 patients (299 male; mean age 35 +/- 15 years) with AM and preserved LVEF. Clinical follow-up was performed for a median of 1,572 days. A clinical combined endpoint of cardiac death, appropriate implantable cardioverter-defibrillator firing, resuscitated cardiac arrest, and hospitalization for heart failure was used.RESULTS Among the 374 patients with suitable images, LGE involved the subepicardial layer inferior and lateral wall in 154 patients (41%; IL group), the midwall layer of the anteroseptal wall in 135 patients (36%; AS [anteroseptal] group), and other segments in 59 patients (16%; other-LGE group), and it was absent in 26 patients (no-LGE group). The AS group had a greater extent of LGE and a higher LV end-diastolic volume index than other groups, but levels of inflammatory markers were lower than in the other groups. Kaplan-Meier curve analysis indicated that the AS group had a worse prognosis than the other groups (p < 0.0001). Finally, in multivariable analysis, AS LGE was the best independent CMR predictor of the combined endpoint (odds ratio: 2.73; 95% confidence interval: 1.2 to 5.9; p = 0.01).CONCLUSIONS In patients with AM and preserved LVEF, LGE in the midwall layer of the AS myocardial segment is associated with a worse prognosis than other patterns of presentation. (C) 2017 by the American College of Cardiology Foundation.