心脏MRI晚期钆增强粒度对缺血性心肌病患者的预后价值。

IF 12.1 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiology Pub Date : 2025-01-01 DOI:10.1148/radiol.240806
Alexandre Unger, Jérôme Garot, Solenn Toupin, Suzanne Duhamel, Francesca Sanguineti, Thomas Hovasse, Stéphane Champagne, Thierry Unterseeh, Bernard Chevalier, Mariama Akodad, Antoinette Neylon, Lounis Hamzi, Trecy Gonçalves, Jeremy Florence, Emmanuel Gall, Paul-Jun Martial, Raphael Mirailles, Alexandre Pfeffer, Elena Sofia Canuti, Jean Guillaume Dillinger, Patrick Henry, Antoine Bondue, Valérie Bousson, Philippe Garot, Théo Pezel
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引用次数: 0

摘要

背景:心脏MRI评估的缺血性晚期钆增强(LGE)是缺血性心肌病的一个公认的预后指标。然而,其他LGE参数的预后价值,如范围、跨壁性、位置和相关的中壁LGE,仍不清楚。目的探讨缺血性LGE特征对缺血性心肌病全因死亡率的预测价值。材料和方法本研究是对一项前瞻性双中心试验的二次分析,参与者为缺血性心肌病和左心室射血分数(LVEF)低于50%,在2008年至2022年期间使用心脏MRI进行生存能力评估。将心脏MRI专家评估的LGE粒度参数(缺血性LGE的程度、跨壁性、位置和相关的中壁LGE)与缺血性心肌病不良事件的传统预后指标(年龄、性别、体重指数、糖尿病、吸烟、血脂异常、心力衰竭住院、心房颤动、肾衰竭、已知心肌梗死和LVEF)进行比较。主要结局为全因死亡率。采用Cox回归分析评估预测价值,并采用时间相关的10年受试者工作特征曲线评估预测价值。心脏MRI LGE评分采用LGE粒度参数。结果6082名参与者(平均年龄64.5岁±11.8 [SD];4419例男性),3591例为缺血性LGE。在中位随访9年(IQR, 6.6-11.5年)期间,652名参与者死亡。缺血性LGE的存在与死亡率密切相关(风险比,3.45 [99.5% CI: 2.55, 4.67];P < 0.001)。在缺血性LGE组,结合这些LGE特征的LGE粒度模型在预测全因死亡率方面的预测价值优于传统预测指标和缺血性LGE程度(10年接受工作特征曲线下面积[AUC], 0.89 [99.5% CI: 0.89, 0.90] vs 0.83 [99.5% CI: 0.83, 0.84];P < 0.001)。缺血性LGE患者的心脏MRI LGE评分表现良好(10年时AUC为0.87 [99.5% CI: 0.85, 0.90])。结论:在缺血性心肌病患者的大队列研究中,LGE粒度模型在预测死亡率方面比传统预测方法具有更高的预测价值。©RSNA, 2025本文可获得补充材料。另见Lima和Ebrahimihoor在本期的社论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic Value of Cardiac MRI Late Gadolinium Enhancement Granularity in Participants with Ischemic Cardiomyopathy.

Background Ischemic late gadolinium enhancement (LGE) assessed with cardiac MRI is a well-established prognosticator in ischemic cardiomyopathy. However, the prognostic value of additional LGE parameters, such as extent, transmurality, location, and associated midwall LGE, remains unclear. Purpose To assess the prognostic value of ischemic LGE features to predict all-cause mortality in ischemic cardiomyopathy. Materials and Methods This study is a secondary analysis of a prospective dual-center trial of participants with ischemic cardiomyopathy and left ventricular ejection fraction (LVEF) under 50% referred for viability assessment using cardiac MRI between 2008 and 2022. The LGE granularity parameters (extent of ischemic LGE, transmurality, location, and associated midwall LGE) assessed by cardiac MRI experts were compared with traditional prognosticators of adverse events in ischemic cardiomyopathy (age, sex, body mass index, diabetes, smoking, dyslipidemia, heart failure hospitalization, atrial fibrillation, renal failure, known myocardial infarction, and LVEF). The primary outcome was all-cause mortality. Predictive value was evaluated using Cox regression analysis and assessed using time-dependent receiver operating characteristic curves at 10 years. The cardiac MRI LGE score was developed using LGE granularity parameters. Results Among 6082 participants (mean age, 64.5 years ± 11.8 [SD]; 4419 men), 3591 had ischemic LGE. During a median follow-up of 9.0 years (IQR, 6.6-11.5 years), 652 participants died. The presence of ischemic LGE was strongly associated with mortality (hazard ratio, 3.45 [99.5% CI: 2.55, 4.67]; P < .001). In the group with ischemic LGE, the LGE granularity model combining these LGE features showed the best predictive value above traditional prognosticators and ischemic LGE extent to predict all-cause mortality (area under the receiving operating characteristic curve [AUC] at 10 years, 0.89 [99.5% CI: 0.89, 0.90] vs 0.83 [99.5% CI: 0.83, 0.84]; P < .001). The cardiac MRI LGE score performed well in participants with ischemic LGE (AUC at 10 years, 0.87 [99.5% CI: 0.85, 0.90]). Conclusion In a large cohort of participants with ischemic cardiomyopathy, an LGE granularity model had a higher prognostic value over traditional prognosticators to predict mortality. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Lima and Ebrahimihoor in this issue.

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来源期刊
Radiology
Radiology 医学-核医学
CiteScore
35.20
自引率
3.00%
发文量
596
审稿时长
3.6 months
期刊介绍: Published regularly since 1923 by the Radiological Society of North America (RSNA), Radiology has long been recognized as the authoritative reference for the most current, clinically relevant and highest quality research in the field of radiology. Each month the journal publishes approximately 240 pages of peer-reviewed original research, authoritative reviews, well-balanced commentary on significant articles, and expert opinion on new techniques and technologies. Radiology publishes cutting edge and impactful imaging research articles in radiology and medical imaging in order to help improve human health.
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