Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis
Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis
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DOI：
10.1186/s12968-019-0520-0
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发表时间：
2019-02-28
影响因子：
6.4
通讯作者：
Kwong, Raymond Y.
中科院分区：
文献类型：
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作者：
Grani, Christoph;Eichhorn, Christian;Kwong, Raymond Y.
背景：虽然心血管磁共振成像（CMR）的晚期钆增强（LGE）的存在是疑似心肌炎患者事件的重要鉴别因素，但没有关于最佳LGE量化方法的数据。方法2002 - 2015年，连续670例疑似心肌炎患者（4816岁，男性59%）入组。我们使用7种不同的信号强度阈值方法进行LGE定量，分别基于远端心肌上方2、3、4、5、6、7个标准差（SD）或半最大值全宽度（FWHM）。此外，评估LGE视觉存在评分（LGE- vps）（每个节段的LGE存在/缺失）。对于每种方法，确定LGE结果与主要不良心脏事件（MACE）的关联强度。使用类内相关系数（ICC）对所有方法进行了类间和类内变异。结果在4.7年的中期随访中，98例（15%）患者出现MACE。FWHM、2- sd和3-SD量化LGE与MACE呈单变量相关性（风险比[HR] 1.05, 95%可信区间[CI]:1.02 ~ 1.08, p=0.001；风险比[HR] 1.02, 95%CI:1.00 ~ 1.04, p=0.001；风险比[HR] 1.02, 95%CI:1.00 ~ 1.05, p=0.035），而通过7-SD方法进行的4-SD未达到显著相关性。LGE-VPS也与MACE相关(HR 1.09, 95%CI: 1.04-1.15, p
BackgroundAlthough the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method.MethodsSix hundred seventy consecutive patients (4816years, 59% male) with suspected myocarditis were enrolled between 2002 and 2015. We performed LGE quantitation using seven different signal intensity thresholding methods based either on 2, 3, 4, 5, 6, 7 standard deviations (SD) above remote myocardium or full width at half maximum (FWHM). In addition, a LGE visual presence score (LGE-VPS) (LGE present/absent in each segment) was assessed. For each of these methods, the strength of association of LGE results with major adverse cardiac events (MACE) was determined. Inter-and intra-rater variability using intraclass-correlation coefficient (ICC) was performed for all methods.ResultsNinety-eight (15%) patients experienced a MACE at a medium follow-up of 4.7years. LGE quantification by FWHM, 2- and 3-SD demonstrated univariable association with MACE (hazard ratio [HR] 1.05, 95% confidence interval [CI]:1.02-1.08, p=0.001; HR 1.02, 95%CI:1.00-1.04; p=0.001; HR 1.02, 95%CI: 1.00-1.05, p=0.035, respectively), whereas 4-SD through 7-SD methods did not reach significant association. LGE-VPS also demonstrated association with MACE (HR 1.09, 95%CI: 1.04-1.15, p