利用多参数心血管磁共振精确预测扩张型心肌病和射血分数轻度降低患者的心衰事件。

IF 16.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
European Journal of Heart Failure Pub Date : 2024-12-01 Epub Date: 2024-08-15 DOI:10.1002/ejhf.3425
Daniel J Hammersley, Srinjay Mukhopadhyay, Xiuyu Chen, Richard E Jones, Aaraby Ragavan, Saad Javed, Husein Rajabali, Emmanuel Androulakis, Lara Curran, Lukas Mach, Zohya Khalique, Resham Baruah, Kaushik Guha, John Gregson, Shihua Zhao, Antonio De Marvao, Upasana Tayal, Amrit S Lota, James S Ware, Dudley J Pennell, Sanjay K Prasad, Brian P Halliday
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引用次数: 0

摘要

目的:评估心血管磁共振(CMR)得出的左心室整体纵向应变(GLS)是否与(i)扩张型心肌病伴射血分数轻度降低(DCMmrEF)患者的进行性心力衰竭(HF)和(ii)心脏性猝死(SCD)有关:我们对通过 CMR 评估的左心室射血分数(LVEF)≥40% 的扩张型心肌病患者进行了前瞻性队列观察研究,包括特征追踪评估左心室 GLS 和晚期钆增强(LGE)。长期判定随访包括:(i) HF 住院、植入 LV 辅助装置或 HF 死亡;(ii) SCD 或中止 SCD(aSCD)。在中位随访 7.8 年(5.2-9.4 年)的 355 名 DCMmrEF 患者(中位年龄 54 岁[四分位间范围 43-64],216 名男性[60.8%],中位 LVEF 49% [46-54])中,32 名患者(9%)发生了 HF 事件,19 名患者(5%)猝死或发生了 aSCD。在多变量模型中,如果将 LV GLS 视为连续变量(百分比危险比 [HR] 1.10,95% 置信区间 [CI] 1.00-1.21,p = 0.045)或二分变量(LV GLS > -15.4%:HR 2.70,95% CI 1.30-5.94,p = 0.008),则其与心房颤动事件相关。LGE 的存在与 HF 事件无关(HR 1.49,95% CI 0.73-3.01,p = 0.270)。相反,LV GLS 与 SCD/aSCD 无关(每% HR 1.07,95% CI 0.95-1.22,p = 0.257),而 LGE 与 SCD/aSCD 有关(HR 3.58,95% CI 1.39-9.23,p = 0.008)。LVEF既与HF事件无关,也与SCD/aSCD无关:结论:多参数 CMR 可对 DCMmrEF 患者进行精确预后分层。LV GLS可对进展性HF风险进行分层,而LGE可对SCD风险进行分层。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Precision prediction of heart failure events in patients with dilated cardiomyopathy and mildly reduced ejection fraction using multi-parametric cardiovascular magnetic resonance.

Precision prediction of heart failure events in patients with dilated cardiomyopathy and mildly reduced ejection fraction using multi-parametric cardiovascular magnetic resonance.

Aims: To assess whether left ventricular (LV) global longitudinal strain (GLS), derived from cardiovascular magnetic resonance (CMR), is associated with (i) progressive heart failure (HF), and (ii) sudden cardiac death (SCD) in patients with dilated cardiomyopathy with mildly reduced ejection fraction (DCMmrEF).

Methods and results: We conducted a prospective observational cohort study of patients with DCM and LV ejection fraction (LVEF) ≥40% assessed by CMR, including feature-tracking to assess LV GLS and late gadolinium enhancement (LGE). Long-term adjudicated follow-up included (i) HF hospitalization, LV assist device implantation or HF death, and (ii) SCD or aborted SCD (aSCD). Of 355 patients with DCMmrEF (median age 54 years [interquartile range 43-64], 216 men [60.8%], median LVEF 49% [46-54]) followed up for a median 7.8 years (5.2-9.4), 32 patients (9%) experienced HF events and 19 (5%) died suddenly or experienced aSCD. LV GLS was associated with HF events in a multivariable model when considered as either a continuous (per % hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.00-1.21, p = 0.045) or dichotomized variable (LV GLS > -15.4%: HR 2.70, 95% CI 1.30-5.94, p = 0.008). LGE presence was not associated with HF events (HR 1.49, 95% CI 0.73-3.01, p = 0.270). Conversely, LV GLS was not associated with SCD/aSCD (per % HR 1.07, 95% CI 0.95-1.22, p = 0.257), whereas LGE presence was (HR 3.58, 95% CI 1.39-9.23, p = 0.008). LVEF was neither associated with HF events nor SCD/aSCD.

Conclusion: Multi-parametric CMR has utility for precision prognostic stratification of patients with DCMmrEF. LV GLS stratifies risk of progressive HF, while LGE stratifies SCD risk.

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来源期刊
European Journal of Heart Failure
European Journal of Heart Failure 医学-心血管系统
CiteScore
27.30
自引率
11.50%
发文量
365
审稿时长
1 months
期刊介绍: European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.
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