{"title":"血管造影衍生的微循环阻力指数对扩张型心肌病患者预后的影响","authors":"Takayuki Kawamura, Koichiro Matsumura, Haruka Minami, Nobuhiro Yamada, Shohei Hakozaki, Yohei Funauchi, Naoko Soejima, Mana Okune, Kazuyoshi Kakehi, Masafumi Ueno, Gaku Nakazawa","doi":"10.1016/j.ijcrp.2025.200467","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Coronary microvascular dysfunction (CMD) has recently been associated with adverse cardiovascular events in patients with heart failure. We investigated the relationship between late gadolinium enhancement (LGE) and CMD, as well as the prognostic value of CMD in predicting long-term prognosis in patients with dilated cardiomyopathy (DCM).</div></div><div><h3>Methods</h3><div>Patients with DCM who underwent both cardiac magnetic resonance imaging and coronary angiography were consecutively enrolled. CMD was evaluated using the angiography-derived index of microcirculatory resistance (angio-IMR). The primary endpoint was composite endpoints of all-cause mortality or heart failure hospitalization within 3 years.</div></div><div><h3>Results</h3><div>Among 108 patients (median age, 64 years; women, 27 %), 18 % (19 patients) experienced composite endpoints. The median angio-IMR was 45 U, and LGE was identified in 23 %. Angio-IMR was significantly higher in patients with LGE than in those without LGE. When patients were stratified based on the combined presence of LGE and angio-IMR, significant differences in composite endpoints were observed among the three groups (LGE absence and low angio-IMR: 4.3 % vs. LGE presence or high angio-IMR: 22.2 % vs. LGE presence and high angio-IMR: 41.2 %, log-rank test p < 0.01). In multivariable Cox proportional hazards model for composite endpoints, LGE presence and angio-IMR >45 U was an independent predictor: hazards ratio 12.20, 95 % confidence interval 2.40–62.10, p = 0.001.</div></div><div><h3>Conclusion</h3><div>CMD evaluated using angio-IMR was associated with LGE and long-term prognosis in patients with DCM. Further investigations are needed to elucidate the relationship among CMD, LGE, and prognosis.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"26 ","pages":"Article 200467"},"PeriodicalIF":2.1000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic impact of angiography-derived index of microcirculatory resistance in patients with dilated cardiomyopathy\",\"authors\":\"Takayuki Kawamura, Koichiro Matsumura, Haruka Minami, Nobuhiro Yamada, Shohei Hakozaki, Yohei Funauchi, Naoko Soejima, Mana Okune, Kazuyoshi Kakehi, Masafumi Ueno, Gaku Nakazawa\",\"doi\":\"10.1016/j.ijcrp.2025.200467\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Coronary microvascular dysfunction (CMD) has recently been associated with adverse cardiovascular events in patients with heart failure. We investigated the relationship between late gadolinium enhancement (LGE) and CMD, as well as the prognostic value of CMD in predicting long-term prognosis in patients with dilated cardiomyopathy (DCM).</div></div><div><h3>Methods</h3><div>Patients with DCM who underwent both cardiac magnetic resonance imaging and coronary angiography were consecutively enrolled. CMD was evaluated using the angiography-derived index of microcirculatory resistance (angio-IMR). The primary endpoint was composite endpoints of all-cause mortality or heart failure hospitalization within 3 years.</div></div><div><h3>Results</h3><div>Among 108 patients (median age, 64 years; women, 27 %), 18 % (19 patients) experienced composite endpoints. The median angio-IMR was 45 U, and LGE was identified in 23 %. Angio-IMR was significantly higher in patients with LGE than in those without LGE. When patients were stratified based on the combined presence of LGE and angio-IMR, significant differences in composite endpoints were observed among the three groups (LGE absence and low angio-IMR: 4.3 % vs. LGE presence or high angio-IMR: 22.2 % vs. LGE presence and high angio-IMR: 41.2 %, log-rank test p < 0.01). In multivariable Cox proportional hazards model for composite endpoints, LGE presence and angio-IMR >45 U was an independent predictor: hazards ratio 12.20, 95 % confidence interval 2.40–62.10, p = 0.001.</div></div><div><h3>Conclusion</h3><div>CMD evaluated using angio-IMR was associated with LGE and long-term prognosis in patients with DCM. Further investigations are needed to elucidate the relationship among CMD, LGE, and prognosis.</div></div>\",\"PeriodicalId\":29726,\"journal\":{\"name\":\"International Journal of Cardiology Cardiovascular Risk and Prevention\",\"volume\":\"26 \",\"pages\":\"Article 200467\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-07-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Cardiology Cardiovascular Risk and Prevention\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772487525001059\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Cardiology Cardiovascular Risk and Prevention","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772487525001059","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
背景冠状动脉微血管功能障碍(CMD)最近被认为与心衰患者的不良心血管事件有关。我们探讨了晚期钆增强(LGE)与CMD的关系,以及CMD在预测扩张型心肌病(DCM)患者长期预后中的预后价值。方法对行心脏磁共振成像和冠状动脉造影的DCM患者进行连续研究。采用血管造影衍生的微循环阻力指数(angio-IMR)评估CMD。主要终点是3年内全因死亡率或心力衰竭住院的复合终点。结果108例患者(中位年龄64岁;女性,27%),18%(19例)经历了复合终点。中位血管imr为45u, 23%为LGE。LGE患者的血管imr明显高于无LGE患者。当患者根据LGE和血管imr的联合存在进行分层时,观察到三组之间的复合终点有显著差异(LGE无和低血管imr: 4.3% vs LGE存在或高血管imr: 22.2% vs LGE存在和高血管imr: 41.2%, log-rank检验p <;0.01)。在复合终点的多变量Cox比例风险模型中,LGE存在和血管imr为独立预测因子:风险比12.20,95%置信区间2.40-62.10,p = 0.001。结论血管imr评价cmd与DCM患者LGE及远期预后相关。CMD、LGE与预后的关系有待进一步研究。
Prognostic impact of angiography-derived index of microcirculatory resistance in patients with dilated cardiomyopathy
Background
Coronary microvascular dysfunction (CMD) has recently been associated with adverse cardiovascular events in patients with heart failure. We investigated the relationship between late gadolinium enhancement (LGE) and CMD, as well as the prognostic value of CMD in predicting long-term prognosis in patients with dilated cardiomyopathy (DCM).
Methods
Patients with DCM who underwent both cardiac magnetic resonance imaging and coronary angiography were consecutively enrolled. CMD was evaluated using the angiography-derived index of microcirculatory resistance (angio-IMR). The primary endpoint was composite endpoints of all-cause mortality or heart failure hospitalization within 3 years.
Results
Among 108 patients (median age, 64 years; women, 27 %), 18 % (19 patients) experienced composite endpoints. The median angio-IMR was 45 U, and LGE was identified in 23 %. Angio-IMR was significantly higher in patients with LGE than in those without LGE. When patients were stratified based on the combined presence of LGE and angio-IMR, significant differences in composite endpoints were observed among the three groups (LGE absence and low angio-IMR: 4.3 % vs. LGE presence or high angio-IMR: 22.2 % vs. LGE presence and high angio-IMR: 41.2 %, log-rank test p < 0.01). In multivariable Cox proportional hazards model for composite endpoints, LGE presence and angio-IMR >45 U was an independent predictor: hazards ratio 12.20, 95 % confidence interval 2.40–62.10, p = 0.001.
Conclusion
CMD evaluated using angio-IMR was associated with LGE and long-term prognosis in patients with DCM. Further investigations are needed to elucidate the relationship among CMD, LGE, and prognosis.