British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
JACC Cardiovasc Imaging. 2015 May;8(5):540-549. doi: 10.1016/j.jcmg.2015.02.005. Epub 2015 Apr 15.
This study aimed to assess the incremental prognostic value of global circumferential strain (GCS), as measured using cardiac magnetic resonance (CMR) tagging, in addition to baseline clinical characteristics, left ventricular ejection fraction (LVEF), and late gadolinium enhancement (LGE), in the prediction of major adverse cardiovascular events (MACE) in an unselected cohort of patients.
LVEF is a powerful predictor of mortality and is used for guiding treatment decisions. It is, however, subject to limitations. The value of GCS measured by CMR tagging in patients with suspected cardiac disease has not been fully explored despite its being considered as the gold standard noninvasive method of assessment of LV deformation.
We prospectively evaluated data from 539 consecutive patients referred for CMR who underwent a CMR protocol that included cine imaging, tagging, and LGE. The primary endpoint was the prevalence of MACE, defined as a composite of all-cause mortality, heart failure-related hospitalization, and aborted sudden cardiac death.
MACE occurred in 62 of 539 patients (11.5%) over a mean follow-up period of 2.2 years. History of ischemic heart disease (IHD) and beta-blocker use were both significant clinical predictors of adverse outcomes. All 3 CMR parameters were significant multivariate predictors of the primary outcome when added to significant clinical predictors (LVEF, hazard ratio [HR]: 0.96 [95% confidence interval [CI]: 0.94 to 0.99; p = 0.005]; presence of LGE, HR: 2.07 [95% CI: 1.03 to 4.14; p = 0.04]; GCS, HR: 1.11 [95% CI: 1.02 to 1.21; p = 0.041]). Global chi-square increased significantly with the addition of both LGE and GCS. Both the presence of LGE and reduced GCS had independent prognostic value in the overall cohort. Patients with LVEF ≥35% but LGE present and reduced GCS had a poor outcome similar to that in those with LVEF <35%.
We found, in a large-scale cohort of patients, that GCS, in addition to clinical variables, LVEF, and LGE, had incremental independent prognostic value. This measure could provide further risk stratification, especially in patients with mild LV impairment.
本研究旨在评估心脏磁共振（CMR）标记测量的整体周向应变（GCS）在预测未经选择的患者中主要不良心血管事件（MACE）方面的附加预后价值，除了基线临床特征、左心室射血分数（LVEF）和晚期钆增强（LGE）以外。
LVEF 是死亡率的有力预测指标，用于指导治疗决策。然而，它存在局限性。尽管 CMR 标记测量的 GCS 被认为是评估 LV 变形的金标准无创方法，但在疑似心脏病患者中的应用价值尚未得到充分探讨。
我们前瞻性评估了 539 例连续接受 CMR 检查的患者的数据，这些患者接受了包括电影成像、标记和 LGE 的 CMR 方案。主要终点是 MACE 的发生率，定义为全因死亡率、心力衰竭相关住院和心源性猝死未遂的复合终点。
在平均 2.2 年的随访期间，539 例患者中有 62 例（11.5%）发生了 MACE。缺血性心脏病（IHD）病史和β受体阻滞剂的使用都是不良结局的显著临床预测因素。当将显著的临床预测因素（LVEF、危险比[HR]：0.96[95%置信区间[CI]：0.94 至 0.99;p=0.005]）加入时，所有 3 个 CMR 参数均为主要结局的多变量显著预测因素；存在 LGE，HR：2.07[95%CI：1.03 至 4.14;p=0.04]）；GCS，HR：1.11[95%CI：1.02 至 1.21;p=0.041]）。随着 LGE 和 GCS 的加入，整体卡方显著性显著增加。在整个队列中，LGE 的存在和 GCS 的降低均具有独立的预后价值。LVEF≥35%但存在 LGE 和 GCS 降低的患者预后不良，与 LVEF<35%的患者相似。
我们在大规模患者队列中发现，除了临床变量、LVEF 和 LGE 外，GCS 还具有独立的预后价值。该指标可提供进一步的风险分层，特别是在 LV 轻度受损的患者中。
