磁共振成像用于识别患有心脏结节病且左心室功能正常或轻度降低、存在室性心律失常风险的患者。
Magnetic resonance imaging for identifying patients with cardiac sarcoidosis and preserved or mildly reduced left ventricular function at risk of ventricular arrhythmias.
作者信息
Crawford Thomas, Mueller Gisela, Sarsam Sinan, Prasitdumrong Hutsaya, Chaiyen Naiyanet, Gu Xiaokui, Schuller Joseph, Kron Jordana, Nour Khaled A, Cheng Alan, Ji Sang Yong, Feinstein Shawn, Gupta Sanjaya, Ilg Karl, Sinno Mohamad, Abu-Hashish Saddam, Al-Mallah Mouaz, Sauer William H, Ellenbogen Kenneth, Morady Fred, Bogun Frank
机构信息
From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
出版信息
Circ Arrhythm Electrophysiol. 2014 Dec;7(6):1109-15. doi: 10.1161/CIRCEP.113.000156. Epub 2014 Sep 29.
BACKGROUND
The purpose of this study was to assess whether delayed enhancement (DE) on MRI is associated with ventricular tachycardia (VT)/ventricular fibrillation or death in patients with cardiac sarcoidosis and left ventricular ejection fraction >35%.
METHODS AND RESULTS
Fifty-one patients with cardiac sarcoidosis and left ventricular ejection fraction >35% underwent DE-MRI. DE was assessed by visual scoring and quantified with the full-width at half-maximum method. The patients were followed for 48.0 ± 20.2 months. Twenty-two of 51 patients (63%) had DE. Forty patients had no prior history of VT (primary prevention cohort). Among those, 3 patients developed VT and 2 patients died. DE was associated with risk of VT/ventricular fibrillation or death (P=0.0032 for any DE and P<0.0001 for right ventricular DE). The positive predictive values of the presence of any DE, multifocal DE, and right ventricular DE for death or VT/ventricular fibrillation at mean follow-up of 48 months were 22%, 48%, and 100%, respectively. Among the 11 patients with a history of VT before the MRI, 10 patients had subsequent VTs, 1 of whom died.
CONCLUSIONS
RV DE in patients with cardiac sarcoidosis is associated with a risk of adverse events in patients with cardiac sarcoidosis and preserved ejection fraction in the absence of a prior history of VT. Patients with DE and a prior history of VT have a high VT recurrence rate. Patients without DE on MRI have a low risk of VT.
背景
本研究旨在评估心脏结节病且左心室射血分数>35%的患者，磁共振成像（MRI）上的延迟强化（DE）是否与室性心动过速（VT）/心室颤动或死亡相关。
方法与结果
51例心脏结节病且左心室射血分数>35%的患者接受了DE-MRI检查。通过视觉评分评估DE，并采用半高宽法进行量化。对患者进行了48.0±20.2个月的随访。51例患者中有22例（63%）存在DE。40例患者既往无VT病史（一级预防队列）。其中，3例患者发生VT，2例患者死亡。DE与VT/心室颤动或死亡风险相关（任何DE的P=0.0032，右心室DE的P<0.0001）。在平均48个月的随访中，任何DE、多灶性DE和右心室DE出现时，死亡或VT/心室颤动的阳性预测值分别为22%、48%和100%。在MRI检查前有VT病史的11例患者中，10例患者随后发生VT，其中1例死亡。
结论
心脏结节病患者的右心室DE与心脏结节病且射血分数保留、无VT既往史患者的不良事件风险相关。有DE且有VT既往史的患者VT复发率高。MRI上无DE的患者VT风险低。
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