Funada Akira, Kanzaki Hideaki, Noguchi Teruo, Morita Yoshiaki, Sugano Yasuo, Ohara Takahiro, Hasegawa Takuya, Hashimura Hiromi, Ishibashi-Ueda Hatsue, Kitakaze Masafumi, Yasuda Satoshi, Ogawa Hisao, Anzai Toshihisa
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Heart Vessels. 2016 May;31(5):758-70. doi: 10.1007/s00380-015-0670-4. Epub 2015 Mar 28.
Hypertrophic cardiomyopathy (HCM) with systolic dysfunction carries a poor prognosis. Although late gadolinium enhancement (LGE) on cardiac magnetic resonance is associated with adverse cardiac events in HCM and is inversely related to left ventricular ejection fraction (LVEF), it is unknown whether LGE or LVEF more accurately predicts adverse cardiac events in HCM with systolic dysfunction. We retrospectively assessed the extent of LGE with a threshold of 6 standard deviations in 46 consecutive HCM patients with systolic dysfunction defined as LVEF <50 % (average 35 ± 12 %) who underwent cardiac magnetic resonance (35 males, mean age 59 ± 14 years). They were followed up over 1755 ± 594 days. The composite adverse cardiac events end point included cardiovascular death, lethal arrhythmia, cardioembolic stroke, and unplanned heart failure hospitalization. LGE was detected in all patients, and the mean extent was 30 ± 15 %. Twenty-nine patients developed adverse cardiac events. Multivariate Cox proportional hazard analysis revealed the extent of LGE as a good independent predictor of adverse cardiac events. Risk increased with the extent of LGE (hazard ratio = 1.62/10 % increase in LGE, 95 % confidence interval = 1.23-2.15, p < 0.001). LVEF was inversely related to the extent of LGE (r = -0.44; p = 0.002) and was also an independent predictor of adverse cardiac events. Risk decreased with LVEF (hazard ratio = 0.68/10 % increase in LVEF, 95 % confidence interval = 0.51-0.91, p = 0.010). The Akaike information criterion evaluating the fit of a model demonstrated that the extent of LGE was a better independent predictor of MACE than LVEF (Akaike information criterion = 172.20 and 178.09, respectively).The extent of LGE was a good independent predictor of adverse cardiac events and reflected mortality and morbidity more precisely than LVEF in HCM with systolic dysfunction.
伴有收缩功能障碍的肥厚型心肌病（HCM）预后较差。尽管心脏磁共振成像上的晚期钆增强（LGE）与HCM的不良心脏事件相关，且与左心室射血分数（LVEF）呈负相关，但尚不清楚LGE或LVEF能否更准确地预测伴有收缩功能障碍的HCM的不良心脏事件。我们回顾性评估了46例连续的伴有收缩功能障碍的HCM患者的LGE范围，这些患者的收缩功能障碍定义为LVEF<50%（平均35±12%），均接受了心脏磁共振成像检查（35例男性，平均年龄59±14岁）。对他们进行了1755±594天的随访。复合不良心脏事件终点包括心血管死亡、致死性心律失常、心源性栓塞性中风和非计划性心力衰竭住院。所有患者均检测到LGE，平均范围为30±15%。29例患者发生了不良心脏事件。多因素Cox比例风险分析显示LGE范围是不良心脏事件的良好独立预测指标。风险随LGE范围增加而增加（风险比=1.62/ LGE每增加10%，95%置信区间=1.23 - 2.15，p<0.001）。LVEF与LGE范围呈负相关（r=-0.44；p=0.002），也是不良心脏事件的独立预测指标。风险随LVEF降低（风险比=0.68/ LVEF每增加10%，95%置信区间=0.51 - 0.91，p=0.010）。评估模型拟合优度的赤池信息准则表明，LGE范围比LVEF是主要不良心血管事件更好的独立预测指标（赤池信息准则分别为172.20和178.09）。在伴有收缩功能障碍的HCM中，LGE范围是不良心脏事件的良好独立预测指标，比LVEF更能准确反映死亡率和发病率。
