Novel Approach to Risk Stratification in Left Ventricular Non-Compaction Using A Combined Cardiac Imaging and Plasma Biomarker Approach.
Novel Approach to Risk Stratification in Left Ventricular Non-Compaction Using A Combined Cardiac Imaging and Plasma Biomarker Approach.
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DOI：
10.1161/jaha.120.019209
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发表时间：
2021-04-20
影响因子：
5.4
通讯作者：
Flamm SD
中科院分区：
文献类型：
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作者：
Ramchand J;Podugu P;Obuchowski N;Harb SC;Chetrit M;Milinovich A;Griffin B;Burrell LM;Wilson Tang WH;Kwon DH;Flamm SD
左心室非压实仍然是一个描述不佳的实体，这导致了过度诊断的挑战。我们的目的是评估薄致密心肌层的存在是否预示着符合心脏磁共振左室非致密标准的个体预后较差。这是一项观察性、回顾性队列研究，涉及从克利夫兰诊所基金会心脏磁共振数据库中选择的个体（N= 26531）。在2000年至2018年期间，根据心脏磁共振彼得森标准，纳入了328例≥12岁的左室非压实或过度小梁患者。研究对象中42%为女性，平均年龄43岁。我们评估了心肌变薄对主要心脏不良事件（包括全因死亡率、心力衰竭住院、左心室辅助装置植入/心脏移植、室性心动过速或缺血性中风）的主要复合终点的预测能力。在平均3.1年的随访中，102例（31%）患者发生了严重的心脏不良事件。在调整合并症后，心肌明显压缩变薄时发生主要心脏不良事件的风险几乎增加了一倍（风险比[HR]， 1.88 [95% CI, 1.18-3.00]； P=0.016），血浆B型利钠肽升高时风险增加了三倍（风险比[HR]， 3.29 [95% CI, 1.52-7.11]； P=0.006），左心室收缩末期容积每增加10个单位，风险比增加5%（风险比，1.01 [95% CI, 1.00-1.01]； P=0.041）。不良临床事件发生的风险在心肌明显致密变薄、B型利钠肽升高或左心室尺寸增大的情况下增加。这些指标的组合可以提高风险评估，以减少左心室非压实过度诊断，同时促进对真正疾病的适当诊断。
Left ventricular non‐compaction remains a poorly described entity, which has led to challenges of overdiagnosis. We aimed to evaluate if the presence of a thin compacted myocardial layer portends poorer outcomes in individuals meeting cardiac magnetic resonance criteria for left ventricular non‐compaction . This was an observational, retrospective cohort study involving individuals selected from the Cleveland Clinic Foundation cardiac magnetic resonance database (N=26 531). Between 2000 and 2018, 328 individuals ≥12 years, with left ventricular non‐compaction or excessive trabeculations based on the cardiac magnetic resonance Petersen criteria were included. The cohort comprised 42% women, mean age 43 years. We assessed the predictive ability of myocardial thinning for the primary composite end point of major adverse cardiac events (composite of all‐cause mortality, heart failure hospitalization, left ventricular assist device implantation/heart transplant, ventricular tachycardia, or ischemic stroke). At mean follow‐up of 3.1 years, major adverse cardiac events occurred in 102 (31%) patients. After adjusting for comorbidities, the risk of major adverse cardiac events was nearly doubled in the presence of significant compacted myocardial thinning (hazard ratio [HR], 1.88 [95% CI, 1.18‒3.00]; P=0.016), tripled in the presence of elevated plasma B‐type natriuretic peptide (HR, 3.29 [95% CI, 1.52‒7.11]; P=0.006), and increased by 5% for every 10‐unit increase in left ventricular end‐systolic volume (HR, 1.01 [95% CI, 1.00‒1.01]; P=0.041). The risk of adverse clinical events is increased in the presence of significant compacted myocardial thinning, an elevated B‐type natriuretic peptide or increased left ventricular dimensions. The combination of these markers may enhance risk assessment to minimize left ventricular non‐compaction overdiagnosis whilst facilitating appropriate diagnoses in those with true disease.