LVEF≤35%扩张型心肌病的预后和风险分层：心脏MRI对更好预后的见解

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-03-01 Epub Date: 2025-03-18 DOI:10.1161/CIRCIMAGING.124.017246

Di Zhou, Leyi Zhu, Shuang Li, Weichun Wu, Baiyan Zhuang, Jing Xu, Wenjing Yang, Jian He, Yining Wang, Yuhui Zhang, Guanshu Liu, Xiaoxin Sun, Qiang Zhang, Zhongzhao Teng, Arlene Sirajuddin, Andrew E Arai, Shihua Zhao, Minjie Lu

{"title":"LVEF≤35%扩张型心肌病的预后和风险分层：心脏MRI对更好预后的见解","authors":"Di Zhou, Leyi Zhu, Shuang Li, Weichun Wu, Baiyan Zhuang, Jing Xu, Wenjing Yang, Jian He, Yining Wang, Yuhui Zhang, Guanshu Liu, Xiaoxin Sun, Qiang Zhang, Zhongzhao Teng, Arlene Sirajuddin, Andrew E Arai, Shihua Zhao, Minjie Lu","doi":"10.1161/CIRCIMAGING.124.017246","DOIUrl":null,"url":null,"abstract":"Background: Current guidelines recommend implantable cardioverter defibrillators for the primary prevention of sudden cardiac death (SCD) in patients with dilated cardiomyopathy with left ventricular ejection fraction (LVEF)≤35%. However, its effectiveness is hindered by the inability to reliably discriminate between the risk of SCD and competing death of heart failure deterioration, thereby limiting its clinical utility. We aimed to refine the SCD risk stratification model based on cardiac magnetic resonance imaging for patients with dilated cardiomyopathy with LVEF≤35%.Methods: A total of 1272 patients with dilated cardiomyopathy with LVEF≤35% who underwent cardiac magnetic resonance imaging were consecutively enrolled in this study. The primary end point is a composite of SCD or aborted SCD and the second end point is a composite of heart failure death and heart transplantation.Results: Over a median follow-up of 86.3 months, 101 patients reached the primary end point. In the adjusted analysis, age (hazard ratio [HR], 1.02 [95% CI, 1.01-1.04]; P=0.006) years, a family history of SCD (HR, 2.00 [95% CI, 1.01-3.98]; P=0.05), NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR, 2.02 [95% CI, 1.18-3.44]; P=0.01), LVEF (per 5% HR, 0.79 [95% CI, 0.66-0.95]; P=0.01), and late gadolinium enhancement≥7.5% (HR, 4.11[95% CI, 2.72-6.21]; P<0.001) were associated with SCD or aborted SCD. Left atrial volume index≥68.3 mL/m2 was an independent predictor of the secondary end point (adjusted HR, 1.65 [95% CI, 1.13-2.40]; P=0.009). Compared with late gadolinium enhancement<7.5%, patients with late gadolinium enhancement≥7.5% and LVEF≤20% had a 7.12-fold higher risk of experiencing SCD events in competing Cox analysis (annual event rate, 4.8%).Conclusions: Patients with dilated cardiomyopathy with late gadolinium enhancement≥7.5% were at heightened risk of SCD events, which can be used for risk assessment. Risk stratifications for SCD, combining clinical and cardiac magnetic resonance imaging may potentially guide decision-making for implantable cardioverter defibrillator therapy.","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":"18 3","pages":"e017246"},"PeriodicalIF":6.5000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913248/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognosis and Risk Stratification in Dilated Cardiomyopathy With LVEF≤35%: Cardiac MRI Insights for Better Outcomes.\",\"authors\":\"Di Zhou, Leyi Zhu, Shuang Li, Weichun Wu, Baiyan Zhuang, Jing Xu, Wenjing Yang, Jian He, Yining Wang, Yuhui Zhang, Guanshu Liu, Xiaoxin Sun, Qiang Zhang, Zhongzhao Teng, Arlene Sirajuddin, Andrew E Arai, Shihua Zhao, Minjie Lu\",\"doi\":\"10.1161/CIRCIMAGING.124.017246\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Current guidelines recommend implantable cardioverter defibrillators for the primary prevention of sudden cardiac death (SCD) in patients with dilated cardiomyopathy with left ventricular ejection fraction (LVEF)≤35%. However, its effectiveness is hindered by the inability to reliably discriminate between the risk of SCD and competing death of heart failure deterioration, thereby limiting its clinical utility. We aimed to refine the SCD risk stratification model based on cardiac magnetic resonance imaging for patients with dilated cardiomyopathy with LVEF≤35%.Methods: A total of 1272 patients with dilated cardiomyopathy with LVEF≤35% who underwent cardiac magnetic resonance imaging were consecutively enrolled in this study. The primary end point is a composite of SCD or aborted SCD and the second end point is a composite of heart failure death and heart transplantation.Results: Over a median follow-up of 86.3 months, 101 patients reached the primary end point. In the adjusted analysis, age (hazard ratio [HR], 1.02 [95% CI, 1.01-1.04]; P=0.006) years, a family history of SCD (HR, 2.00 [95% CI, 1.01-3.98]; P=0.05), NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR, 2.02 [95% CI, 1.18-3.44]; P=0.01), LVEF (per 5% HR, 0.79 [95% CI, 0.66-0.95]; P=0.01), and late gadolinium enhancement≥7.5% (HR, 4.11[95% CI, 2.72-6.21]; P<0.001) were associated with SCD or aborted SCD. Left atrial volume index≥68.3 mL/m2 was an independent predictor of the secondary end point (adjusted HR, 1.65 [95% CI, 1.13-2.40]; P=0.009). Compared with late gadolinium enhancement<7.5%, patients with late gadolinium enhancement≥7.5% and LVEF≤20% had a 7.12-fold higher risk of experiencing SCD events in competing Cox analysis (annual event rate, 4.8%).Conclusions: Patients with dilated cardiomyopathy with late gadolinium enhancement≥7.5% were at heightened risk of SCD events, which can be used for risk assessment. Risk stratifications for SCD, combining clinical and cardiac magnetic resonance imaging may potentially guide decision-making for implantable cardioverter defibrillator therapy.\",\"PeriodicalId\":10202,\"journal\":{\"name\":\"Circulation: Cardiovascular Imaging\",\"volume\":\"18 3\",\"pages\":\"e017246\"},\"PeriodicalIF\":6.5000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913248/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCIMAGING.124.017246\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.124.017246","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

背景：目前的指南推荐植入式心律转复除颤器用于左室射血分数(LVEF)≤35%的扩张型心肌病患者心源性猝死（SCD）的一级预防。然而，由于无法可靠地区分SCD风险和心力衰竭恶化导致的竞争性死亡，其有效性受到阻碍，从而限制了其临床应用。我们旨在完善LVEF≤35%的扩张型心肌病患者基于心脏磁共振成像的SCD风险分层模型。方法：连续选取1272例LVEF≤35%的扩张型心肌病患者行心脏磁共振成像。主要终点是SCD或SCD流产的组合，第二个终点是心力衰竭死亡和心脏移植的组合。结果：在86.3个月的中位随访中，101例患者达到了主要终点。在校正分析中，年龄(风险比[HR]， 1.02 [95% CI, 1.01-1.04]；P=0.006)岁，有SCD家族史(HR, 2.00 [95% CI, 1.01-3.98]；P=0.05), NT-proBNP （n端前b型利钠肽）(HR, 2.02 [95% CI, 1.18-3.44]；P = 0.01), LVEF(每5%的人力资源,0.79(95%可信区间,0.66 - -0.95);P=0.01)，晚期钆增强≥7.5% (HR, 4.11[95% CI, 2.72 ~ 6.21]；P2是次要终点的独立预测因子(调整后HR， 1.65 [95% CI, 1.13-2.40]；P = 0.009)。结论：晚期钆增强≥7.5%的扩张型心肌病患者发生SCD事件的风险增高，可用于风险评估。SCD的风险分层，结合临床和心脏磁共振成像可能指导植入式心律转复除颤器治疗的决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Prognosis and Risk Stratification in Dilated Cardiomyopathy With LVEF≤35%: Cardiac MRI Insights for Better Outcomes.

Background: Current guidelines recommend implantable cardioverter defibrillators for the primary prevention of sudden cardiac death (SCD) in patients with dilated cardiomyopathy with left ventricular ejection fraction (LVEF)≤35%. However, its effectiveness is hindered by the inability to reliably discriminate between the risk of SCD and competing death of heart failure deterioration, thereby limiting its clinical utility. We aimed to refine the SCD risk stratification model based on cardiac magnetic resonance imaging for patients with dilated cardiomyopathy with LVEF≤35%.

Methods: A total of 1272 patients with dilated cardiomyopathy with LVEF≤35% who underwent cardiac magnetic resonance imaging were consecutively enrolled in this study. The primary end point is a composite of SCD or aborted SCD and the second end point is a composite of heart failure death and heart transplantation.

Results: Over a median follow-up of 86.3 months, 101 patients reached the primary end point. In the adjusted analysis, age (hazard ratio [HR], 1.02 [95% CI, 1.01-1.04]; P=0.006) years, a family history of SCD (HR, 2.00 [95% CI, 1.01-3.98]; P=0.05), NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR, 2.02 [95% CI, 1.18-3.44]; P=0.01), LVEF (per 5% HR, 0.79 [95% CI, 0.66-0.95]; P=0.01), and late gadolinium enhancement≥7.5% (HR, 4.11[95% CI, 2.72-6.21]; P<0.001) were associated with SCD or aborted SCD. Left atrial volume index≥68.3 mL/m² was an independent predictor of the secondary end point (adjusted HR, 1.65 [95% CI, 1.13-2.40]; P=0.009). Compared with late gadolinium enhancement<7.5%, patients with late gadolinium enhancement≥7.5% and LVEF≤20% had a 7.12-fold higher risk of experiencing SCD events in competing Cox analysis (annual event rate, 4.8%).

Conclusions: Patients with dilated cardiomyopathy with late gadolinium enhancement≥7.5% were at heightened risk of SCD events, which can be used for risk assessment. Risk stratifications for SCD, combining clinical and cardiac magnetic resonance imaging may potentially guide decision-making for implantable cardioverter defibrillator therapy.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.