Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Int J Cardiovasc Imaging. 2010 Feb;26 Suppl 1:123-31. doi: 10.1007/s10554-009-9574-7. Epub 2010 Jan 5.
To determine the prognosis of a myocardial scar assessed by a late gadolinium enhancement (LGE) technique of cardiac magnetic resonance (CMR) in hypertensive patients with known or suspected coronary artery disease (CAD). Patients with systemic hypertension with known or suspected CAD without a clinical history of myocardial infarction were enrolled. All patients underwent CMR for assessment of cardiac function and LGE. Prognostic data was determined by the occurrence of a hard cardiac endpoint, defined as cardiac death or a non-fatal myocardial infarction, or major adverse cardiac events (MACEs), defined as cardiac death, a non-fatal myocardial infarction, or hospitalization due to heart failure, unstable angina, or life-threatening ventricular arrhythmia. A total of 1,644 patients were enrolled; 48% were males and the mean age was 65 +/- 11 years. The average follow-up time was 863 +/- 559 days. Four hundred fifty-three (28%) patients had LGE. LGE was the strongest and most independent predictor for hard events and MACEs with hazard ratios of 4.77 and 3.38, respectively. Other independent predictors of hard events and MACEs were left ventricular ejection fraction and mass, the use of a beta-blocker, and a history of heart failure. The risk of cardiac events increased as the extent of LGE increased; the hazard ratio was 12.74 for hard events for those with a LGE >20% of the myocardium. LGE is the most important and independent predictor for cardiac events in hypertensive patients with known or suspected CAD.
评估患有已知或疑似冠状动脉疾病（CAD）的高血压患者的心肌瘢痕预后的心脏磁共振（CMR）延迟钆增强（LGE）技术。患有已知或疑似 CAD 的系统性高血压且无心肌梗死临床病史的患者入选。所有患者均行 CMR 检查以评估心功能和 LGE。预后数据通过硬心终点的发生来确定，硬心终点定义为心脏死亡或非致命性心肌梗死，或主要不良心脏事件（MACE），定义为心脏死亡、非致命性心肌梗死或因心力衰竭、不稳定型心绞痛或危及生命的室性心律失常而住院。共纳入 1644 例患者；48%为男性，平均年龄为 65 +/- 11 岁。平均随访时间为 863 +/- 559 天。453（28%）例患者有 LGE。LGE 是硬事件和 MACE 的最强和最独立的预测因素，风险比分别为 4.77 和 3.38。硬事件和 MACE 的其他独立预测因素是左心室射血分数和质量、β受体阻滞剂的使用以及心力衰竭史。随着 LGE 程度的增加，心脏事件的风险增加；对于 LGE 超过心肌的 20%的患者，硬事件的风险比为 12.74。LGE 是患有已知或疑似 CAD 的高血压患者心脏事件的最重要和独立的预测因素。
