Hichem Sakhi, Gilles Soulat, Damian Craiem, Umit Gencer, Jérôme Lamy, Valentina Stipechi, Tania Puscas, Jean-Sébastien Hulot, Albert Hagege, Elie Mousseaux
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引用次数: 0
Abstract
Purpose To investigate whether the peak early filling rate normalized to the filling volume (PEFR/FV) estimated from four-dimensional (4D) flow cardiac MRI may be used to assess impaired left ventricular (LV) filling and predict clinical outcomes in individuals with hypertrophic cardiomyopathy (HCM). Materials and Methods Cardiac MRI with a 4D flow sequence and late gadolinium enhancement (LGE), as well as echocardiography, was performed in 88 individuals: 44 participants with HCM from a French prospective registry (ClinicalTrials.gov; NCT01091480) and 44 healthy volunteers matched for age and sex. In participants with HCM, a composite primary end point was assessed at follow-up, including unexplained syncope, new-onset atrial fibrillation, hospitalization for congestive heart failure, ischemic stroke, sustained ventricular arrhythmia, septal reduction therapy, and cardiac death. A Cox proportional hazard model was used to analyze associations with the primary end point. Results PEFR/FV was significantly lower in the HCM group (mean age, 51.8 years ± 18.5 [SD]; 29 male participants) compared with healthy volunteers (mean, 3.35 sec-1 ± 0.99 [0.90-5.20] vs 4.42 sec-1 ± 1.68 [2.74-11.86]; P < .001) and correlated with both B-type natriuretic peptide (BNP) level (r = -0.31; P < .001) and the ratio of pulsed Doppler early transmitral inflow to Doppler tissue imaging annulus velocities (E/E'; r = -0.54; P < .001). At a median follow-up of 2.3 years (IQR, 1.7-3.3 years), the primary end point occurred in 14 (32%) participants. A PEFR/FV of 2.61 sec-1 or less was significantly associated with occurrence of the primary end point (hazard ratio, 9.46 [95% CI: 2.61, 45.17; P < .001] to 15.21 [95% CI: 3.51, 80.22; P < .001]), independently of age, BNP level, E/E', LGE extent, and LV and left atrial strain according to successive bivariate models. Conclusion In HCM, LV filling evaluated with 4D flow cardiac MRI correlated with Doppler and biologic indexes of diastolic dysfunction and predicted clinical outcomes. Keywords: Diastolic Function, Left Ventricular Filling, Hypertrophic Cardiomyopathy, Cardiac MRI, 4D Flow Sequence Clinical trial registration no. NCT01091480 Supplemental material is available for this article. © RSNA, 2024.
四维流式心脏磁共振成像显示左心室二尖瓣充盈受损与肥厚型心肌病预后的关系
目的 研究通过四维(4D)血流心脏磁共振成像估算的早期充盈峰值率与充盈容积(PEFR/FV)的归一化值是否可用于评估肥厚型心肌病(HCM)患者左心室(LV)充盈受损的情况并预测临床预后。材料和方法 对 88 名患者进行了 4D 血流序列和晚期钆增强 (LGE) 心脏 MRI 以及超声心动图检查:44 名 HCM 患者来自法国前瞻性登记处(ClinicalTrials.gov; NCT01091480),44 名健康志愿者年龄和性别匹配。在 HCM 患者中,随访评估了一个复合主要终点,包括不明原因晕厥、新发心房颤动、充血性心力衰竭住院、缺血性中风、持续室性心律失常、室间隔减容治疗和心源性死亡。采用 Cox 比例危险模型分析与主要终点的关系。结果 与健康志愿者相比,HCM 组(平均年龄 51.8 岁 ± 18.5 [SD];29 名男性参与者)的 PEFR/FV 明显较低(平均值 3.35 sec-1 ± 0.99 [0.90-5.20] vs 4.42 sec-1 ± 1.68 [2.74-11.86];P < .001),并与 B 型钠尿肽(BNP)水平(r = -0.31;P < .001)和脉冲多普勒早期透射瓣流入量与多普勒组织成像瓣环速度之比(E/E';r = -0.54;P < .001)相关。在中位随访 2.3 年(IQR,1.7-3.3 年)时,14 名参与者(32%)出现了主要终点。根据连续的双变量模型,PEFR/FV 为 2.61 sec-1 或更低与主要终点的发生显著相关(危险比为 9.46 [95% CI: 2.61, 45.17; P < .001] 至 15.21 [95% CI: 3.51, 80.22; P < .001]),与年龄、BNP 水平、E/E'、LGE 程度以及左心室和左心房应变无关。结论 在 HCM 中,用四维血流心脏 MRI 评估的左心室充盈度与舒张功能障碍的多普勒和生物学指标相关,并可预测临床预后。关键词: 舒张功能 左心室舒张功能 左心室充盈 肥厚型心肌病 心脏核磁共振成像 四维血流序列 临床试验注册号本文有补充材料。© RSNA, 2024.
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