Gommans D H Frank, Cramer G Etienne, Fouraux Michael A, Bakker Jeannette, Michels Michelle, Dieker Hendrik-Jan, Timmermans Janneke, Marcelis Carlo L M, Verheugt Freek W A, de Boer Menko-Jan, Kofflard Marcel J M, de Boer Rudolf A, Brouwer Marc A
Department of Cardiology, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands.
Department of Cardiology, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands.
Am J Cardiol. 2018 Aug 1;122(3):483-489. doi: 10.1016/j.amjcard.2018.04.020. Epub 2018 May 1.
In nonhigh risk patients with hypertrophic cardiomyopathy (HC), the presence of extensive late gadolinium enhancement (LGE) at cardiovascular magnetic resonance (CMR) imaging has been proposed as a risk modifier in the decision process for implantable cardioverter defibrillator implantation. With a pretest risk of about 10%, a strategy that alters the likelihood of LGE could markedly affect efficacious CMR imaging. Our aim was to study the potential of clinical variables and biomarkers to predict LGE. In 98 HC patients without any clear indication for implantable cardioverter defibrillator implantation, we determined the discriminative values of a set of clinical variables and a panel of biomarkers (hs-cTnT, NTproBNP, GDF-15, and Gal-3, CICP) for LGE, that is, LGE ≥15% of the left ventricular mass. LGE was present in 10% (10/98) of patients. The clinical prediction model contained a history of nonsustained ventricular tachycardia, maximal wall thickness and reduced systolic function (c-statistic: 0.868, p <0.001). Of all biomarkers, only hs-cTnT was associated with LGE, in addition to the improved clinical model of diagnostic accuracy (p = 0.04). A biomarker-only strategy allowed the exclusion of LGE in half of the cohort, in case of a hs-cTnT concentration less than the optimal cutoff (Youden index; 8 ng/L-sensitivity 100%, specificity 54%). In conclusion, in this nonhigh risk HC cohort, the pretest likelihood of LGE can be altered using clinical variables and the addition of hs-cTnT. The promising findings with the use of hs-cTnT only call for new initiatives to study its impact on efficacious CMR imaging in a larger HC population, either with or without additional use of clinical variables.
在非高危肥厚型心肌病（HC）患者中，心血管磁共振（CMR）成像时广泛晚期钆增强（LGE）的存在已被提议作为植入式心脏复律除颤器植入决策过程中的风险修正因素。对于约10%的预测试风险，改变LGE可能性的策略可能会显著影响CMR成像的有效性。我们的目的是研究临床变量和生物标志物预测LGE的潜力。在98例无植入式心脏复律除颤器植入明确指征的HC患者中，我们确定了一组临床变量和一组生物标志物（高敏心肌肌钙蛋白T[hs-cTnT]、N末端B型利钠肽原[NTproBNP]、生长分化因子15[GDF-15]、半乳糖凝集素-3[Gal-3]、交联C端肽[CICP]）对LGE（即LGE≥左心室质量的15%）的判别价值。10%（10/98）的患者存在LGE。临床预测模型包括非持续性室性心动过速病史、最大壁厚和收缩功能降低（c统计量：0.868，p<0.001）。在所有生物标志物中，除了提高诊断准确性的临床模型外，只有hs-cTnT与LGE相关（p = 0.04）。仅使用生物标志物的策略在一半队列中排除了LGE，前提是hs-cTnT浓度低于最佳临界值（约登指数；8 ng/L，敏感性100%，特异性54%）。总之，在这个非高危HC队列中，可使用临床变量和添加hs-cTnT来改变LGE的预测试可能性。仅使用hs-cTnT的有前景的发现需要新的举措来研究其在更大HC人群中对有效CMR成像的影响，无论是否额外使用临床变量。
