Pontone Gianluca, Guaricci Andrea I, Andreini Daniele, Solbiati Anna, Guglielmo Marco, Mushtaq Saima, Baggiano Andrea, Beltrama Virginia, Fusini Laura, Rota Cristina, Segurini Chiara, Conte Edoardo, Gripari Paola, Dello Russo Antonio, Moltrasio Massimo, Tundo Fabrizio, Lombardi Federico, Muscogiuri Giuseppe, Lorenzoni Valentina, Tondo Claudio, Agostoni Piergiuseppe, Bartorelli Antonio L, Pepi Mauro
From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., S.M., A.B., V.B., L.F., C.S., E.C., P.G., A.D.R., M.M., F.T., C.T., P.A., A.L.B., M.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Department of Cardiovascular Sciences and Community Health, University of Milan, Italy (D.A., A.S., C.R., F.L., P.A.); UOC Malattie Cardiovascolari, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy (F.L.); Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy (A.L.B.).
Circ Cardiovasc Imaging. 2016 Oct;9(10). doi: 10.1161/CIRCIMAGING.115.004956.
The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter-defibrillator therapy.
We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: -4.9±10%) as compared to TTE (P<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3-3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4-3.6]) were independently associated with MACE (P<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283-0.654; P<0.001) and 0.413 (95% confidence interval, 0.23-0.63; P<0.001), respectively.
CMR provides additional prognostic stratification as compared to TTE, which may have direct impact on the indication of implantable cardioverter-defibrillator implantation.
本研究旨在确定在接受一级预防植入式心脏复律除颤器治疗评估的缺血性心肌病和非缺血性扩张型心肌病患者中，心脏磁共振成像（CMR）相对于经胸超声心动图（TTE）的预后益处。
我们连续纳入了409例缺血性和扩张型心肌病患者（平均年龄：64±12岁；男性331例）。所有患者均接受了TTE和CMR检查，并评估了左心室舒张末期容积、左心室收缩末期容积和左心室射血分数（LVEF）。此外，还评估了钆延迟强化情况。所有患者均随访主要不良心脏事件（MACE），其定义为非持续性室性心动过速、持续性室性心动过速、心脏性猝死未遂或心脏性猝死的综合终点。中位随访时间为545天。与TTE相比，CMR显示出更高的左心室舒张末期容积（平均差值：43±22.5 mL）、更高的左心室收缩末期容积（平均差值：34±20.5 mL）和更低的LVEF（平均差值：-4.9±10%）（P<0.01）。103例（25%）患者发生了MACE。与未发生MACE的患者相比，发生MACE的患者在两种成像方式下均显示出更高的左心室舒张末期容积、更高的左心室收缩末期容积和更低的LVEF，且每位患者钆延迟强化的患病率更高。在多变量分析中，CMR-LVEF≤35%（风险比=2.18 [1.3-3.8]）和钆延迟强化的存在（风险比=2.2 [1.4-3.6]）与MACE独立相关（P<0.01）。与TTE-LVEF相比，基于CMR-LVEF≤35%或CMR-LVEF≤35%加钆延迟强化检测的模型在预测MACE方面表现更优，净重新分类改善分别为0.468（95%置信区间，0.283-0.654；P<0.001）和0.413（95%置信区间，0.23-0.63；P<0.001）。
与TTE相比，CMR提供了额外的预后分层，这可能对植入式心脏复律除颤器植入的指征有直接影响。
