JACC Cardiovasc Imaging. 2009 Dec;2(12):1369-77. doi: 10.1016/j.jcmg.2009.08.008.
We sought to assess the diagnostic accuracy and incremental prognostic value of delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR) compared with electrocardiographic and transthoracic echocardiographic (TTE) parameters in such patients.
Utility of DHE-CMR in the diagnosis of patients with suspected cardiac amyloidosis (CA) has recently been demonstrated, but its incremental prognostic utility is unclear.
Forty-seven consecutive patients (mean age 63 years, 70% men, 55% New York Heart Association functional class >II) with suspected CA who underwent electrocardiography (ECG), TTE, DHE-CMR, and biopsy (38 endomyocardial, 9 extracardiac) were studied. Low voltage on ECG was defined as S-wave in lead V(1) + R-wave in lead V(5) or V(6) <15 mm. TTE parameters, including deceleration time, E/E' ratio, and diastolic grade were recorded. CMR was considered positive with diffuse DHE of the subendocardium extending to adjacent myocardium. All-cause mortality was ascertained.
In the study population, 59% had low voltage on ECG, 30% had abnormal deceleration time < OR = 150 ms, 38% had E/E' ratio >15, and 47% had advanced (pseudonormal or restrictive) diastology.The diagnostic accuracy of DHE-CMR in patients undergoing endomyocardial biopsy was as follows: sensitivity 88%, specificity 90%, positive predictive value 88%, and negative predictive value 90%. On multivariable logistic regression testing of the diagnostic ability of various noninvasive imaging parameters, only DHE-CMR was significant (Wald chi-square statistic 9.6, p < 0.01). At 1-year post-biopsy, there were 9 (19%) deaths. On Cox proportional hazards analysis, only positive DHE-CMR was a predictor of 1-year mortality (Wald chi-square statistic 4.91, p = 0.03).
A characteristic DHE-CMR pattern is more accurate for diagnosis and is a stronger predictor of 1-year mortality in patients with suspected CA as compared with other noninvasive parameters.
我们旨在评估延迟强化心脏磁共振（DHE-CMR）与心电图和经胸超声心动图（TTE）参数相比，在疑似心脏淀粉样变性（CA）患者中的诊断准确性和增量预后价值。
DHE-CMR 在诊断疑似心脏淀粉样变性（CA）患者中的应用价值已得到近期研究证实，但它在预后方面的增量价值尚不清楚。
本研究纳入了 47 例连续疑似 CA 患者（平均年龄 63 岁，70%为男性，55%为纽约心脏协会功能分级> II 级），这些患者接受了心电图（ECG）、TTE、DHE-CMR 和活检（38 例心内膜下，9 例心外膜下）。心电图低电压定义为 V(1)导联 S 波+V(5)或 V(6)导联 R 波<15mm。记录 TTE 参数，包括减速时间、E/E'比值和舒张分级。CMR 结果阳性定义为心内膜下弥漫性延迟强化，延伸至邻近心肌。所有原因的死亡率均被确定。
在研究人群中，59%的患者心电图低电压，30%的患者减速时间异常<或=150ms，38%的患者 E/E'比值>15，47%的患者舒张功能异常（假性正常或限制性）。行心内膜下活检的患者中，DHE-CMR 的诊断准确性如下：敏感性 88%，特异性 90%，阳性预测值 88%，阴性预测值 90%。在多变量逻辑回归检验各种非侵入性成像参数的诊断能力时，只有 DHE-CMR 具有统计学意义（Wald χ²统计量 9.6，p<0.01）。在活检后 1 年，有 9 例（19%）死亡。在 Cox 比例风险分析中，只有 DHE-CMR 阳性是 1 年死亡率的预测因素（Wald χ²统计量 4.91，p=0.03）。
与其他非侵入性参数相比，DHE-CMR 具有特征性的延迟强化模式，在疑似 CA 患者的诊断中更为准确，且是 1 年死亡率的更强预测因素。
