Cheong Benjamin Y C, Muthupillai Raja, Wilson James M, Sung Angela, Huber Steffen, Amin Samir, Elayda MacArthur A, Lee Vei-Vei, Flamm Scott D
Department of Diagnostic and Interventional Radiology, St. Luke's Episcopal Hospital and the Texas Heart Institute, 6720 Bertner Ave, MC 2-270, Houston, TX 77030, USA.
Circulation. 2009 Nov 24;120(21):2069-76. doi: 10.1161/CIRCULATIONAHA.109.852517. Epub 2009 Nov 9.
Left ventricular ejection fraction is a powerful independent predictor of survival in cardiac patients, especially those with coronary artery disease. Delayed-enhancement magnetic resonance imaging (DE-MRI) can accurately identify irreversible myocardial injury with high spatial and contrast resolution. To date, relatively limited data are available on the prognostic value of DE-MRI, so we sought to determine whether DE-MRI findings independently predict survival.
The medical records of 857 consecutive patients who had complete cine and DE-MRI evaluation at a tertiary care center were reviewed regardless of whether the patients had coronary artery disease. The presence and extent of myocardial scar were evaluated qualitatively by a single experienced observer. The primary, composite end point was all-cause mortality or cardiac transplantation. Survival data were obtained from the Social Security Death Index. The median follow-up was 4.4 years; 252 patients (29%) reached one of the end points. Independent predictors of mortality or transplantation included congestive heart failure, ejection fraction, and age (P<0.0001 for each), as well as scar index (hazard ratio, 1.26; 95% confidence interval, 1.02 to 1.55; P=0.033). Similarly, in subsets of patients with or without coronary artery disease, scar index also independently predicted mortality or transplantation (hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.68; P=0.018; and hazard ratio, 5.65; 95% confidence interval, 1.74 to 18.3; P=0.004, respectively). Cox regression analysis showed worse outcome in patients with any DE in addition to depressed left ventricular ejection fraction (<50%).
The degree of DE detected by DE-MRI appears to strongly predict all-cause mortality or cardiac transplantation after adjustment for traditional, well-known prognosticators.
左心室射血分数是心脏病患者，尤其是冠心病患者生存的有力独立预测指标。延迟强化磁共振成像（DE-MRI）能够以高空间分辨率和对比度分辨率准确识别不可逆性心肌损伤。迄今为止，关于DE-MRI预后价值的数据相对有限，因此我们试图确定DE-MRI检查结果是否能独立预测生存情况。
回顾了在一家三级医疗中心连续接受完整电影磁共振成像和DE-MRI评估的857例患者的病历，无论患者是否患有冠心病。由一名经验丰富的观察者对心肌瘢痕的存在和范围进行定性评估。主要复合终点为全因死亡率或心脏移植。生存数据来自社会保障死亡指数。中位随访时间为4.4年；252例患者（29%）达到终点之一。死亡率或移植的独立预测因素包括充血性心力衰竭、射血分数和年龄（每项P<0.0001），以及瘢痕指数（风险比，1.26；95%置信区间，1.02至1.55；P=0.033）。同样，在有或无冠心病的患者亚组中，瘢痕指数也独立预测死亡率或移植（风险比分别为1.33；95%置信区间，1.05至1.68；P=0.018；以及风险比5.65；95%置信区间，1.74至18.3；P=0.004）。Cox回归分析显示，除左心室射血分数降低（<50%）外，任何出现DE的患者预后较差。
在对传统的、众所周知的预后因素进行调整后，DE-MRI检测到的DE程度似乎能强烈预测全因死亡率或心脏移植。
