Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London; National Heart & Lung Institute, Imperial College, London.
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London.
JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1645-1655. doi: 10.1016/j.jcmg.2018.07.015. Epub 2018 Sep 12.
This study sought to investigate the association between the extent, location, and pattern of late gadolinium enhancement (LGE) and outcome in a large dilated cardiomyopathy (DCM) cohort.
The relationship between LGE and prognosis in DCM is incompletely understood.
The authors examined the association between LGE and all-cause mortality and a sudden cardiac death (SCD) composite based on the extent, location, and pattern of LGE in DCM.
Of 874 patients (588 men, median age 52 years) followed for a median of 4.9 years, 300 (34.3%) had nonischemic LGE. Estimated adjusted hazard ratios for patients with an LGE extent of 0 to 2.55%, 2.55% to 5.10%, and >5.10%, respectively, were 1.59 (95% confidence interval [CI]: 0.99 to 2.55), 1.56 (95% CI: 0.96 to 2.54), and 2.31 (95% CI: 1.50 to 3.55) for all-cause mortality, and 2.79 (95% CI: 1.42 to 5.49), 3.86 (95% CI: 2.09 to 7.13), and 4.87 (95% CI: 2.78 to 8.53) for the SCD endpoint. There was a marked nonlinear relationship between LGE extent and outcome such that even small amounts of LGE predicted a substantial increase in risk. The presence of septal LGE was associated with increased mortality, but SCD was most associated with the combined presence of septal and free-wall LGE. Predictive models using LGE presence and location were superior to models based on LGE extent or pattern.
In DCM, the presence of septal LGE is associated with a large increase in the risk of death and SCD events, even when the extent is small. SCD risk is greatest with concomitant septal and free-wall LGE. The incremental value of LGE extent beyond small amounts and LGE pattern is limited.
本研究旨在探讨大型扩张型心肌病（DCM）患者群体中晚期钆增强（LGE）的范围、位置和模式与结局之间的关系。
DCM 中 LGE 与预后之间的关系尚未完全阐明。
作者根据 DCM 中 LGE 的范围、位置和模式，研究了 LGE 与全因死亡率和心脏性猝死（SCD）复合终点之间的关联。
在 874 例患者（588 例男性，中位年龄 52 岁）中，中位随访时间为 4.9 年，300 例（34.3%）患者存在非缺血性 LGE。LGE 范围分别为 0%至 2.55%、2.55%至 5.10%和>5.10%的患者的估计校正后风险比分别为 1.59（95%置信区间[CI]：0.99 至 2.55）、1.56（95% CI：0.96 至 2.54）和 2.31（95% CI：1.50 至 3.55）的全因死亡率，SCD 终点的风险比分别为 2.79（95% CI：1.42 至 5.49）、3.86（95% CI：2.09 至 7.13）和 4.87（95% CI：2.78 至 8.53）。LGE 范围与结局之间存在显著的非线性关系，即使 LGE 量很小，也预示着风险的大幅增加。室间隔 LGE 的存在与死亡率增加相关，但 SCD 与室间隔和游离壁 LGE 的联合存在最相关。使用 LGE 存在和位置的预测模型优于基于 LGE 范围或模式的模型。
在 DCM 中，即使 LGE 范围较小，室间隔 LGE 的存在也与死亡和 SCD 事件风险的大幅增加相关。伴有室间隔和游离壁 LGE 时 SCD 风险最大。LGE 范围超过少量和 LGE 模式的增量价值有限。
