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心脏磁共振检测的心肌纤维化与肥厚型心肌病患者Tp-e间期、5年心源性猝死风险评分之间的关系。

The relationship between myocardial fibrosis detected by cardiac magnetic resonance and Tp-e interval, 5-year sudden cardiac death risk score in hypertrophic cardiomyopathy patients.

作者信息

Riza Demir Ali, Celik Ömer, Sevinç Samet, Uygur Begüm, Kahraman Serkan, Yilmaz Emre, Cemek Mete, Onal Yilmaz, Erturk Mehmet

机构信息

Department of Cardiology, University of Health Science, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

Department of Cardiology, Akçakale State Hospital, Urfa, Turkey.

出版信息

Ann Noninvasive Electrocardiol. 2019 Sep;24(5):e12672. doi: 10.1111/anec.12672. Epub 2019 Jun 1.

Abstract

BACKGROUND

The aim of this study was to investigate the relationship between QT (QTc) interval, Tp-e interval, Tp-e/QTc ratio, 5-year sudden cardiac death (SCD) risk score, and late gadolinium enhancement (LGE) detected by CMR in hypertrophic cardiomyopathy (HCM) patients.

METHOD

A total of 74 consecutive patients who underwent CMR with HCM diagnosis were included in the study. These patients were divided into two groups according to the presence of LGE on CMR. All patients underwent detailed echocardiography and QTc interval, Tp-e interval, and Tp-e/QTc ratios and 5-year SCD risk scores were calculated. These parameters were compared for two groups.

RESULTS

CMR revealed LGE in 32 (43.2%) of 74 HCM patients. In the group with LGE, significantly higher QTc interval (p = 0.002), Tp-e interval (p < 0.001), Tp-e/QTc ratio (p = 0.004), and 5-year SCD risk score were detected. In addition, QTc interval, Tp-e interval, Tp-e/QTc ratio, maximum wall thickness, left ventricular mass index, 5-year SCD risk score, and cardiac fibrosis index were found to be correlated with various degrees in correlation analysis. Also, Tp-e interval is found to be an independent predictor of LGE detected by CMR in HCM patients (p = 0.017, OR [%95 CI] = 1.017 [1.001-1.034]). In addition, the Tp-e interval can detect the LGE with a sensitivity of 64.3% and a specificity of 84.2% at 99.4 ms. (p < 0.001, AUC [95% CI] = 0.790 [0.676-0.905]).

CONCLUSION

The Tp-e interval can be used to optimize SCD risk stratification in HCM patients and determine which patients will benefit from implantable cardioverter-defibrillator (ICD) treatment.

摘要

背景

本研究旨在探讨肥厚型心肌病(HCM)患者的QT(QTc)间期、Tp-e间期、Tp-e/QTc比值、5年心源性猝死(SCD)风险评分与心脏磁共振成像(CMR)检测到的晚期钆增强(LGE)之间的关系。

方法

本研究共纳入74例连续接受CMR检查且诊断为HCM患者。根据CMR上是否存在LGE将这些患者分为两组。所有患者均接受详细的超声心动图检查,并计算QTc间期、Tp-e间期、Tp-e/QTc比值以及5年SCD风险评分。对两组的这些参数进行比较。

结果

CMR显示74例HCM患者中有32例(43.2%)存在LGE。在存在LGE的组中,检测到QTc间期(p = 0.002)、Tp-e间期(p < 0.001)、Tp-e/QTc比值(p = 0.004)以及5年SCD风险评分显著更高。此外,在相关性分析中发现QTc间期、Tp-e间期、Tp-e/QTc比值、最大壁厚、左心室质量指数、5年SCD风险评分以及心脏纤维化指数存在不同程度的相关性。而且,发现Tp-e间期是CMR检测到的HCM患者LGE的独立预测因子(p = 0.017,OR[95%CI]=1.017[1.001 - 1.034])。此外,Tp-e间期在99.4毫秒时检测LGE的灵敏度为64.3%,特异度为84.2%(p < 0.001,AUC[95%CI]=0.790[0.676 - 0.905])。

结论

Tp-e间期可用于优化HCM患者的SCD风险分层,并确定哪些患者将从植入式心脏复律除颤器(ICD)治疗中获益。

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本文引用的文献

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Fibrosis and wall thickness affect ventricular repolarization dynamics in hypertrophic cardiomyopathy.
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