非缺血性扩张型心肌病患者右心室心尖部延迟钆增强的预后意义：一项多中心回顾性队列研究。
Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study.
机构信息
Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
出版信息
PLoS One. 2018 Nov 28;13(11):e0208100. doi: 10.1371/journal.pone.0208100. eCollection 2018.
INTRODUCTION
The presence of late gadolinium enhancement (LGE) at the right ventricular insertion point (RVIP) on cardiac magnetic resonance (CMR) is generally believed to be nonspecific, but the clinical implication of this unique LGE pattern in patients with non-ischemic dilated cardiomyopathy (NICM) has not been elucidated.
OBJECTIVES
We investigated the prognostic significance of RVIP-LGE in NICM patients.
METHODS
A total of 360 consecutive NICM patients referred for CMR (102 with no LGE, 50 with RVIP-LGE, 121 with left ventricular [LV]-LGE, and 87 with both an LV and RVIP-LGE) were studied. The primary endpoint was a composite of the all-cause death, hospitalization due to worsening of heart failure, and major arrhythmic events.
RESULTS
During a mean follow-up of 45.2 ± 36.5 months, 149 (41.4%) patients (22 [21.6%] no LGE vs. 16 [32.0%] RVIP-LGE vs. 62 [51.2%] LV-LGE vs. 49 [56.3%] both LV and RVIP-LGE, P < 0.0001) reached the primary endpoint. A Kaplan Meier curve demonstrated that RVIP-LGE patients had an intermediate trend of an event free survival rate for the composite endpoint (log-rank P < 0.0001). In a multivariable Cox regression model, LV-LGE (P = 0.008) and both LV and RVIP-LGE (P = 0.003) were significantly associated with a worse outcome, whereas RVIP-LGE was not (P = 0.101). In addition, RVIP-LGE patients (n = 32) had a more favorable outcome compared to LV-LGE patients (n = 32) even after matching the extent of the LGE (median 3.4% [interquartile range, 3.1-3.8], 8 [25.0%] RVIP-LGE vs. 20 [62.5%] LV-LGE, P = 0.002).
CONCLUSIONS
LGE confined to the RVIP among NICM patients did not significantly increase the risk of adverse cardiac events, and also showed a better outcome than the same extent of LGE located in the LV. Identification of this unique LGE distribution may help refine the current risk stratification.
简介
心脏磁共振（CMR）上右心室插入点（RVIP）的晚期钆增强（LGE）通常被认为是非特异性的，但在非缺血性扩张型心肌病（NICM）患者中，这种独特的 LGE 模式的临床意义尚未阐明。
目的
我们研究了 NICM 患者 RVIP-LGE 的预后意义。
方法
共研究了 360 例连续的 NICM 患者进行 CMR（102 例无 LGE，50 例 RVIP-LGE，121 例 LV-LGE，87 例同时有 LV 和 RVIP-LGE）。主要终点是全因死亡、因心力衰竭恶化而住院和主要心律失常事件的复合终点。
结果
在平均 45.2±36.5 个月的随访中，149 例（41.4%）患者（22 例无 LGE，16 例 RVIP-LGE，62 例 LV-LGE，49 例同时有 LV 和 RVIP-LGE，P<0.0001）达到了主要终点。Kaplan-Meier 曲线显示，RVIP-LGE 患者的复合终点无事件生存率呈中间趋势（对数秩 P<0.0001）。在多变量 Cox 回归模型中，LV-LGE（P=0.008）和同时有 LV 和 RVIP-LGE（P=0.003）与预后不良显著相关，而 RVIP-LGE 则没有（P=0.101）。此外，即使在匹配 LGE 范围后（中位数 3.4%[四分位距，3.1-3.8]，32 例 RVIP-LGE 与 32 例 LV-LGE，P=0.002），RVIP-LGE 患者（n=32）的结局也比 LV-LGE 患者（n=32）更有利。
结论
NICM 患者中局限于 RVIP 的 LGE 并未显著增加不良心脏事件的风险，并且其结局也优于位于 LV 的相同程度的 LGE。这种独特的 LGE 分布的识别可能有助于完善当前的危险分层。
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