Wan Ke, Sun Jiayu, Han Yuchi, Luo Yong, Liu Hong, Yang Dan, Cheng Wei, Zhang Qing, Zeng Zhi, Chen Yucheng
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Heart Vessels. 2018 Feb;33(2):170-179. doi: 10.1007/s00380-017-1043-y. Epub 2017 Aug 24.
Few studies have focused on right ventricular (RV) involvement in cardiac amyloidosis (CA). We investigated the prognostic value of RV assessment by cardiovascular magnetic resonance (CMR) in CA. In 2011-2014, consecutive patients with suspected CA referred for CMR were retrospectively evaluated. Demographic and baseline clinical characteristics were collected. Healthy volunteers were matched for sex and age and served as controls. All subjects underwent a contrast-enhanced CMR examination. RV size, function, and late gadolinium enhancement (LGE) were analyzed. All deaths during follow-up were recorded. Sixty-one patients [37 males (60.7%), age 60 ± 11 years] were included; CA was diagnosed in 47 (77.0%) patients. CA patients displayed decreased biventricular ejection fraction, elevated left ventricular mass index, and increased biventricular end-systolic volume index (ESVi) compared with controls. A total of 27 deaths (57.4%) occurred in the CA group at 21-month median follow-up. Multivariable analysis demonstrated that RVESVi (HR 1.033, 95% CI 1.004-1.063, P = 0.026) and RV-LGE (HR 2.814, 95% CI 1.063-7.450, P = 0.037) were independent predictors of mortality in CA. For all amyloid patients, log NT-proBNP (HR 3.412; 95% CI 1.484-7.845; P = 0.004) and RV-LGE (HR 4.149; 95% CI 1.623-10.607; P = 0.003) were identified as independent predictors. RVESVi and RV-LGE are independent predictors of survival and evaluation of RV by CMR enables risk stratification in patients with CA.
很少有研究关注心脏淀粉样变性（CA）中右心室（RV）受累情况。我们研究了通过心血管磁共振（CMR）评估RV在CA中的预后价值。在2011年至2014年期间，对连续转诊进行CMR检查的疑似CA患者进行回顾性评估。收集人口统计学和基线临床特征。选择年龄和性别匹配的健康志愿者作为对照。所有受试者均接受了对比增强CMR检查。分析RV大小、功能和晚期钆增强（LGE）情况。记录随访期间的所有死亡情况。纳入61例患者[37例男性（60.7%），年龄60±11岁]；47例（77.0%）患者被诊断为CA。与对照组相比，CA患者双心室射血分数降低、左心室质量指数升高、双心室收缩末期容积指数（ESVi）增加。在中位随访21个月时，CA组共有27例死亡（57.4%）。多变量分析表明，RVESVi（HR 1.033，95%CI 1.004 - 1.063，P = 0.026）和RV-LGE（HR 2.814，95%CI 1.063 - 7.450，P = 0.037）是CA患者死亡率的独立预测因素。对于所有淀粉样变性患者，log NT-proBNP（HR 3.412；95%CI 1.484 - 7.845；P = 0.004）和RV-LGE（HR 4.149；95%CI 1.623 - 10.607；P = 0.003）被确定为独立预测因素。RVESVi和RV-LGE是生存的独立预测因素，通过CMR评估RV能够对CA患者进行危险分层。
