心脏磁共振评估扩张型心肌病患者左心室小梁化的临床及预后相关性

Clinical and prognostic relevancy of left ventricular trabeculation assessed by cardiac magnetic resonance in patients with dilated cardiomyopathy.

作者信息

Mazurkiewicz Łukasz, Petryka Joanna, Śpiewak Mateusz, Miłosz-Wieczorek Barbara, Małek Łukasz A, Jasińska Anna, Jarmus Ewelina, Marczak Magdalena, Misko Jolanta, Grzybowski Jacek

机构信息

Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland, Poland; CMR Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland, Poland.

出版信息

Kardiol Pol. 2017;75(8):794-803. doi: 10.5603/KP.a2017.0097. Epub 2017 May 25.

DOI:10.5603/KP.a2017.0097

PMID:28541593

Abstract

BACKGROUND AND AIM

We sought to search for factors associated with the magnitude of trabeculation by cardiac magnetic resonance, and evaluate the impact of trabeculations on outcomes in patients with dilated cardiomyopathy (DCM).

METHODS

We evaluated clinical profiles and outcomes of 276 subjects with DCM (age: 33.2 ± 13.3 years, 160 males). Trabeculation was quantified as trabeculated/total myocardial mass ratio (TM/M). Subjects were stratified into three subgroups (A, B, and C) according to the tertiles of rising TM/M values (33% ranges). A group of 30 healthy subjects served as controls. Patients were prospectively followed-up in search of major adverse cardiovascular events for 2.4 years on average (range 0.2-3.9 years).

RESULTS

Dilated cardiomyopathy patients had more trabeculation than controls (27.1 ± 16.9% vs. 17.3 ± 8.1, p < 0.01). Group C subjects had lowest N-terminal pro-B-type natriuretic peptide (NT-proBNP) (1445 [984-3843] vs. 873 [440-2633] vs. 529 [206-1221] pg/mL, p < 0.01), higher ejection fraction (23.9 ± 10.4 vs. 25.0 ± 9.2 vs. 32.4 ± 2.7%, p = 0.03), and lower left ventricular mass index (LVMI) (91.3 ± 21.5 vs. 74.3 ± 31.1 vs. 55.7 ± 23.2 g/m2, p < 0.01). They also had fewer areas of late gadolinium enhancement (69 [46.3%] vs. 31 [38.2%] vs. 15 [32.6%], p = 0.01). Male sex (b = 0.21, SE = 0.13; p = 0.01), LVMI (b = -0.32, SE = 0.08, p < 0.01) and NT-proBNP (b = -0.05, SE = 0.02, p = 0.02) were independently related to TM/M. The magnitude of trabeculation was not a predictor of major adverse cardiovascular events. Prognosis was impacted by left ventricular end-diastolic volume index only (HR 2.538, 95% CI -1.734-3.218, p < 0.01).

CONCLUSIONS

Trabeculation patterns relate to cardiac function and neurohormonal activation but not to survival.

摘要

背景与目的

我们试图通过心脏磁共振寻找与小梁化程度相关的因素，并评估小梁化对扩张型心肌病（DCM）患者预后的影响。

方法

我们评估了276例DCM患者（年龄：33.2±13.3岁，男性160例）的临床特征和预后。小梁化程度通过小梁化心肌质量与总心肌质量之比（TM/M）进行量化。根据TM/M值升高的三分位数（范围为33%）将受试者分为三个亚组（A、B和C）。30名健康受试者作为对照组。对患者进行前瞻性随访，平均随访2.4年（范围0.2 - 3.9年）以寻找主要不良心血管事件。

结果

扩张型心肌病患者的小梁化程度高于对照组（27.1±16.9%对17.3±8.1%，p<0.01）。C组受试者的N末端B型利钠肽原（NT - proBNP）最低（1445[984 - 3843]对873[440 - 2633]对529[206 - 1221]pg/mL，p<0.01），射血分数较高（23.9±10.4对25.0±9.2对32.4±2.7%，p = 0.03），左心室质量指数（LVMI）较低（91.3±21.5对74.3±31.1对55.7±23.2 g/m²，p<0.01）。他们的钆延迟强化区域也较少（69[46.3%]对31[38.2%]对15[32.6%]，p = 0.01）。男性（b = 0.21，SE = 0.13；p = 0.01）、LVMI（b = -0.32，SE = 0.08，p<0.01）和NT - proBNP（b = -0.05，SE = 0.02，p = 0.02）与TM/M独立相关。小梁化程度不是主要不良心血管事件的预测指标。仅左心室舒张末期容积指数影响预后（HR 2.538，95%CI -1.734 - 3.218，p<0.01）。