Merlo Marco, Masè Marco, Vitrella Giancarlo, Belgrano Manuel, Faganello Giorgio, Di Giusto Federico, Boscutti Andrea, Gobbo Marco, Gigli Marta, Altinier Alessandro, Lesizza Pierluigi, Barbati Giulia, Ramani Federica, De Luca Antonio, Morea Gaetano, Cova Maria Assunta, Stolfo Davide, Sinagra Gianfranco
Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS), Trieste 34100, Italy.
Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS), Trieste 34100, Italy.
Am J Cardiol. 2018 Aug 1;122(3):490-497. doi: 10.1016/j.amjcard.2018.04.017. Epub 2018 May 21.
Defining short-term prognosis in nonischemic cardiomyopathy (NICM) is challenging in clinical practice. Although left ventricular reverse remodeling (LVRR) is a key prognostic marker in NICM there are few parameters able to predict it. We investigated whether a complete structural and functional cardiac magnetic resonance imaging (cMRI) evaluation was incremental to the classic clinical-echocardiographic approach in predicting LVRR in a large cohort of NICM patients receiving evidence-based treatment. Patients with a recent diagnosis of NICM (<3 months) who underwent complete clinical, echocardiographic and cMRI assessment were consecutively enrolled from 2008 to 2016. LVRR was defined as an increase in ≥10 points or normalization of left ventricular ejection fraction, associated with a ≥10% reduction or normalization of left ventricular end-diastolic diameter at midterm (median time 20 months) echocardiographic follow-up. Among 80 NICM patients included in the study, LVRR was observed in 43 (54%). At multivariate analysis, the clinical-echocardiographic evaluation failed to identify independent predictors of LVRR. However, absence of late gadolinium enhancement (odds ratio [OR] 9.07; confidence interval [CI] 2.7 to 13.1; p value 0.0003), left ventricular mass (OR 1.018; CI 1.001 to 1.036; p value 0.045) and peak circumferential strain (OR 1.213; CI 1.011 to 1.470; p value 0.049) assessed by cMRI were independently associated with LVRR. A model for LVRR prediction based on cMRI and clinical-echocardiographic parameters performed significantly better than the clinical-echocardiographic model alone (area under curve 0.84 vs 0.72; p value 0.023). In conclusion, an integrated imaging approach with the addition of a structural and functional cMRI study to the standard-of-care evaluation improves the prediction of LVRR in a large cohort of patients with recently diagnosed NICM receiving evidence-based treatment.
在临床实践中，定义非缺血性心肌病（NICM）的短期预后具有挑战性。尽管左心室逆向重构（LVRR）是NICM的关键预后标志物，但能够预测它的参数很少。我们调查了在接受循证治疗的一大群NICM患者中，完整的心脏结构和功能磁共振成像（cMRI）评估相对于经典临床超声心动图方法在预测LVRR方面是否具有增量价值。2008年至2016年连续纳入近期诊断为NICM（<3个月）且接受了完整临床、超声心动图和cMRI评估的患者。LVRR定义为左心室射血分数增加≥10分或恢复正常，且在中期（中位时间20个月）超声心动图随访时左心室舒张末期直径减少≥10%或恢复正常。在纳入研究的80例NICM患者中，43例（54%）观察到LVRR。多变量分析显示，临床超声心动图评估未能识别出LVRR的独立预测因素。然而，cMRI评估的无晚期钆增强（比值比[OR] 9.07；置信区间[CI] 2.7至13.1；p值0.0003）、左心室质量（OR 1.018；CI 1.001至1.036；p值0.045）和峰值圆周应变（OR 1.213；CI 1.011至1.470；p值0.049）与LVRR独立相关。基于cMRI和临床超声心动图参数的LVRR预测模型的表现明显优于单独的临床超声心动图模型（曲线下面积0.84对0.72；p值0.023）。总之，在标准治疗评估中增加结构和功能cMRI研究的综合成像方法可改善对一大群近期诊断为NICM且接受循证治疗患者的LVRR预测。
