利用延迟钆增强边缘区通过心血管磁共振预测缺血性和非缺血性心肌病患者合适的植入式心律转复除颤器治疗：四种分析方法的比较
Cardiovascular Magnetic Resonance to Predict Appropriate Implantable Cardioverter Defibrillator Therapy in Ischemic and Nonischemic Cardiomyopathy Patients Using Late Gadolinium Enhancement Border Zone: Comparison of Four Analysis Methods.
作者信息
Jablonowski Robert, Chaudhry Uzma, van der Pals Jesper, Engblom Henrik, Arheden Håkan, Heiberg Einar, Wu Katherine C, Borgquist Rasmus, Carlsson Marcus
机构信息
From the Clinical Physiology (R.J., H.E., H.A., E.H., M.C.) and Cardiology (U.C., J.v.d.P., R.B.), Department of Clinical Sciences, Lund University, Lund University Hospital, Sweden; Department of Biomedical Engineering and Centre for Mathematical Sciences, Faculty of Engineering, Lund University, Sweden (E.H.); and Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (K.C.W.).
出版信息
Circ Cardiovasc Imaging. 2017 Sep;10(9). doi: 10.1161/CIRCIMAGING.116.006105.
BACKGROUND
Late gadolinium enhancement (LGE) border zone on cardiac magnetic resonance imaging has been proposed as an independent predictor of ventricular arrhythmias. The purpose was to determine whether size and heterogeneity of LGE predict appropriate implantable cardioverter defibrillator (ICD) therapy in ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) patients and to evaluate 4 LGE border-zone algorithms.
METHODS AND RESULTS
ICM and NICM patients who underwent LGE cardiac magnetic resonance imaging prior to ICD implantation were retrospectively included. Two semiautomatic algorithms, expectation maximization, weighted intensity, a priori information and a weighted border zone algorithm, were compared with a modified full-width half-maximum and a 2-3SD threshold-based algorithm (2-3SD). Hazard ratios were calculated per 1% increase in LGE. A total of 74 ICM and 34 NICM were followed for 63 months (1-140) and 52 months (0-133), respectively. ICM patients had 27 appropriate ICD events, and NICM patients had 7 ICD events. In ICM patients with primary prophylactic ICD, LGE border zone predicted ICD therapy in univariable and multivariable analysis measured by the expectation maximization, weighted intensity, a priori information, weighted border zone, and modified full-width half-maximum algorithms (hazard ratios 1.23, 1.22, and 1.05, respectively; <0.05; negative predictive value 92%). For NICM, total LGE by all 4 methods was the strongest predictor (hazard ratios, 1.03-1.04; <0.05), though the number of events was small.
CONCLUSIONS
Appropriate ICD therapy can be predicted in ICM patients with primary prevention ICD by quantifying the LGE border zone. In NICM patients, total LGE but not LGE border zone had predictive value for ICD therapy. However, the algorithms used affects the predictive value of these measures.
背景
心脏磁共振成像上的延迟钆增强（LGE）边界区已被提出作为室性心律失常的独立预测指标。目的是确定LGE的大小和异质性是否能预测缺血性心肌病（ICM）和非缺血性心肌病（NICM）患者的合适植入式心律转复除颤器（ICD）治疗，并评估4种LGE边界区算法。
方法与结果
回顾性纳入在ICD植入前接受LGE心脏磁共振成像检查的ICM和NICM患者。将两种半自动算法，即期望最大化、加权强度、先验信息和加权边界区算法，与改良的半高宽算法和基于2-3标准差阈值的算法（2-3SD）进行比较。计算LGE每增加1%时的风险比。共对74例ICM患者和34例NICM患者分别随访了63个月（1-140个月）和52个月（0-133个月）。ICM患者发生27次合适的ICD事件，NICM患者发生7次ICD事件。在接受一级预防性ICD治疗的ICM患者中，LGE边界区在单变量和多变量分析中通过期望最大化、加权强度、先验信息、加权边界区和改良半高宽算法预测ICD治疗（风险比分别为1.23、1.22和1.05；P<0.05；阴性预测值92%）。对于NICM，尽管事件数量较少，但所有4种方法测得的总LGE是最强的预测指标（风险比为1.03-1.04；P<0.05）。
结论
通过量化LGE边界区可预测接受一级预防ICD治疗的ICM患者的合适ICD治疗。在NICM患者中，总LGE而非LGE边界区对ICD治疗具有预测价值。然而，所使用的算法会影响这些指标的预测价值。
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