College of Medicine and Public Health, Flinders University, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Australia; Cardiac Imaging Research Group, South Australian Health & Medical Research Institute, Australia.
College of Medicine and Public Health, Flinders University, Australia.
Int J Cardiol. 2019 Apr 1;280:124-129. doi: 10.1016/j.ijcard.2019.01.018. Epub 2019 Jan 9.
Presence of myocardial fibrosis in well-established non-ischaemic dilated cardiomyopathy (NIDCM) is associated with adverse clinical outcomes. However, the impact of myocardial fibrosis at first presentation in NIDCM, and its long-term association with left ventricular (LV) dysfunction, heart failure (HF) and ventricular arrhythmia (VA) remains unclear. We investigated whether the presence of myocardial fibrosis quantified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) at presentation, is independently associated with long-term major adverse cardiovascular events (MACE) in patients with first presentation NIDCM.
Consecutive patients with a first diagnosis of NIDCM were recruited. Patients underwent LGE-CMR at baseline. Replacement myocardial fibrosis by LGE-CMR was quantified by experienced observers blinded to patient outcome. MACE was defined as a composite end-point including cardiac death, HF rehospitalisation and the occurrence of sustained VA.
Fifty-one patients with first presentation NIDCM were included, of which 49 (96%) had follow up and outcome data. Median follow up was 8.2 years. Both the LGE positive and LGE negative groups had similar clinical characteristics at follow up. In univariate Cox regression analysis, positive LGE was associated with MACE (HR:3.44; 95% CI:1.89 to 6.24, p-value < 0.001) and HF rehospitalisation (HR:2.89; 95% CI:1.42 to 5.85, p-value = 0.003). In multivariate Cox regression, positive LGE-CMR was independently associated with MACE (HR:3.53; 95% CI:1.51 to 8.27, p-value = 0.004) and HF rehospitalisation (HR:3.07; 95% CI:1.24 to 7.59, p-value = 0.015).
The presence of myocardial fibrosis in first presentation NIDCM is independently associated with an increased risk of HF rehospitalisation, at long term follow-up.
在已确立的非缺血性扩张型心肌病（NIDCM）中存在心肌纤维化与不良临床结局相关。然而，NIDCM 首次就诊时心肌纤维化的影响及其与左心室（LV）功能障碍、心力衰竭（HF）和室性心律失常（VA）的长期关联仍不清楚。我们研究了在 NIDCM 首次就诊时通过晚期钆增强心血管磁共振（LGE-CMR）量化的心肌纤维化的存在是否与首次就诊 NIDCM 患者的长期主要不良心血管事件（MACE）独立相关。
连续招募首次诊断为 NIDCM 的患者。患者在基线时接受 LGE-CMR 检查。由经验丰富的观察者对 LGE-CMR 进行定量评估，观察者对患者的结果不知情。MACE 定义为包括心脏死亡、HF 再住院和持续性 VA 发生的复合终点。
共纳入 51 例首次就诊 NIDCM 的患者，其中 49 例（96%）有随访和结局数据。中位随访时间为 8.2 年。LGE 阳性组和 LGE 阴性组在随访时具有相似的临床特征。在单变量 Cox 回归分析中，LGE 阳性与 MACE（HR：3.44；95%CI：1.89 至 6.24，p 值<0.001）和 HF 再住院（HR：2.89；95%CI：1.42 至 5.85，p 值=0.003）相关。在多变量 Cox 回归中，LGE-CMR 阳性与 MACE（HR：3.53；95%CI：1.51 至 8.27，p 值=0.004）和 HF 再住院（HR：3.07；95%CI：1.24 至 7.59，p 值=0.015）独立相关。
NIDCM 首次就诊时存在心肌纤维化与长期随访时 HF 再住院风险增加独立相关。
