CNR Institute of Clinical Physiology, Pisa, Italy; Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
Fondazione Toscana G. Monasterio, CNR, Regione Toscana, Pisa, Italy; Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
Int J Cardiol. 2017 Oct 15;245:13-19. doi: 10.1016/j.ijcard.2017.07.064. Epub 2017 Jul 20.
Few studies have explored prognosis in patients with previous myocardial infarction (MI) with mild-moderate (MM) left ventricular (LV) dysfunction (D). The aim of our study was to investigate whether combining LV parameters obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous MI and MM-LV-D.
In 418 consecutive patients (63.3±11.3years old, female 12.9%) with previous MI, we quantified LVEF, volumes and wall motion score index (WMSI) and measured the infarct extent by late gadolinium enhancement (LGE). According to LVEF, patients were considered with normal LVEF (>55%), MM-LV-D (LVEF>30 and ≤55%) and severe (S) LV-D (LVEF ≤30).
During follow-up (median, 39.7months) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 17/99 of patients with S-LV-D, in 15/201 with MM-LV-D, and in only 1/118 of those with normal LV-EF. After adjustment for age, an extent of LGE >11.3%, a dilated LV (male >112ml/m; female >92ml/m) and a WMSI>1.59 were associated with adverse cardiac events in patients with MM-LV-D. In patients with MM-LV-D, when each of these 3 factors was observed, the prognosis was worse respect to those with 1-2 factors and no factor (p=0.035 and p=0.004, respectively). Prognosis was similar (p=0.61) between MM-LV-D patients with all 3 factors and those with S-LV-dysfunction.
A multiparametric CMR approach, which includes LGE, dilated LV and WMSI, permits to identify post MI patients with MM-LV-D with a risk of cardiac events similar to those with S-LV-D. Further multicenter studies are needed to confirm our data.
很少有研究探讨有轻度至中度左心室（LV）功能障碍（D）的既往心肌梗死（MI）患者的预后。我们的研究目的是探讨通过心脏磁共振（CMR）获得的 LV 参数是否可以改善既往 MI 和 MM-LV-D 患者的风险分层。
在 418 例连续患者（63.3±11.3 岁，女性 12.9%）中，我们定量测量 LVEF、容积和壁运动评分指数（WMSI），并用晚期钆增强（LGE）测量梗死范围。根据 LVEF，患者被认为具有正常 LVEF（>55%）、MM-LV-D（LVEF>30 且≤55%）和严重（S）LV-D（LVEF≤30）。
在随访期间（中位数为 39.7 个月），S-LV-D 患者中有 17/99 例、MM-LV-D 患者中有 15/201 例、正常 LVEF 患者中仅有 1/118 例发生心脏事件（心脏死亡或适当的心脏内除颤电击）。调整年龄后，LGE 范围>11.3%、LV 扩张（男性>112ml/m；女性>92ml/m）和 WMSI>1.59 与 MM-LV-D 患者的不良心脏事件相关。在 MM-LV-D 患者中，当观察到这 3 个因素中的任何一个时，与有 1-2 个因素和无因素的患者相比，预后更差（p=0.035 和 p=0.004）。MM-LV-D 患者中，所有 3 个因素与 S-LV-D 患者的预后相似（p=0.61）。
一种多参数 CMR 方法，包括 LGE、LV 扩张和 WMSI，可以识别出有 MM-LV-D 的既往 MI 患者，其心脏事件风险与 S-LV-D 患者相似。需要进一步的多中心研究来证实我们的数据。
