Comparative prognostic importance of measures of left atrial structure and function in non-ischaemic dilated cardiomyopathy.

IF 6.7 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Daniel J Hammersley, Srinjay Mukhopadhyay, Xiuyu Chen, Leanne Cheng, Richard E Jones, Lukas Mach, Lara Curran, Momina Yazdani, Alma Iacob, Amrit S Lota, Zohya Khalique, Antonio De Marvao, Resham Baruah, Kaushik Guha, James S Ware, John Gregson, Shihua Zhao, Dudley J Pennell, Upasana Tayal, Sanjay K Prasad, Brian P Halliday
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引用次数: 0

Abstract

Aims: This study aimed to compare the association between measures of left atrial (LA) structure and function, derived from cardiovascular magnetic resonance (CMR), with cardiovascular death or non-fatal heart failure events in patients with non-ischaemic dilated cardiomyopathy (DCM).

Methods and results: CMR studies of 580 prospectively recruited patients with DCM in sinus rhythm [median age 54 (interquartile range 44-64) years, 61% men, median left ventricular ejection fraction 42% (30-51%)] were analysed for measures of LA structure [LA maximum volume index (LAVImax) and LA minimum volume index (LAVImin)] and function (LA emptying fraction, LA reservoir strain, LA conduit strain (LACS), and LA booster strain]. Over a median follow-up of 7.4 years, 103 patients (18%) met the primary endpoint. Apart from LACS, each measure of LA structure and function was associated with the primary endpoint after adjusting for other important prognostic variables. The addition of each LA metric to a baseline model containing the same important prognostic covariates improved model discrimination, with LAVImin providing the greatest improvement [C-statistic improvement: 0.702-0.738; χ2 test comparing likelihood ratio P < 0.0001; categorical net reclassification index: 0.210 (95% CI 0.023-0.392)]. Patients in the highest tercile of LAVImin had similar event rates to those with persistent atrial fibrillation. Measures of LA strain did not enhance model discrimination above LA volumetric measures.

Conclusion: Measures of LA structure and function offer important prognostic information in patients with DCM and enhance the prediction of adverse outcomes. LA strain was not incremental to volumetric analysis for risk prediction.

非缺血性扩张型心肌病左心房结构和功能测量的预后重要性比较。
目的:比较心血管磁共振(CMR)得出的左心房(LA)结构和功能指标与非缺血性扩张型心肌病(DCM)患者心血管(CV)死亡或非致死性心力衰竭(HF)事件之间的关联:对前瞻性招募的 580 名窦性心律的 DCM 患者(中位年龄 54 [四分位间范围 44-64] 岁,61% 为男性,中位 LVEF 42% [30-51%])进行了 CMR 研究,分析了 LA 结构的测量指标(左心房最大容积指数 [LAVImax]、左心房最小容积指数 [LAVImax]、左心房最小容积指数 [LAVImax])、左心房最小容积指数 [LAVImin])和功能(左心房排空分数 [LAEF]、左心房储腔应变 [LARS]、左心房导管应变 [LACS] 和左心房增压应变 [LABS])。中位随访时间为 7.4 年,103 名患者(18%)达到了主要终点。除 LACS 外,在调整其他重要预后变量后,LA 结构和功能的各项指标均与主要终点相关。在包含相同重要预后协变量的基线模型中加入每种 LA 指标都提高了模型的区分度,其中 LAVImin 的提高幅度最大(C 统计量的提高幅度从 0.702 到 0.7):C统计量的提高:0.702 到 0.738;比较似然比 p 的 χ2 检验 结论:左心房结构的测量与预后相关因素的比较,可以提高模型的判别能力:左心房结构和功能的测量为 DCM 患者提供了重要的预后信息,并增强了对不良预后的预测。在风险预测方面,LA 应变与容积分析相比并不具有增效作用。
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来源期刊
European Heart Journal - Cardiovascular Imaging
European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
11.60
自引率
9.70%
发文量
708
审稿时长
4-8 weeks
期刊介绍: European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.
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