Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland; Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.
Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
J Cardiol. 2020 Jan;75(1):20-26. doi: 10.1016/j.jjcc.2019.09.003. Epub 2019 Oct 4.
The risk of adverse events in patients with left ventricular non-compaction cardiomyopathy (LVNC) is substantial. Information on prognostic factors, however, is limited. This study was designed to assess the prognostic value of right ventricular (RV) size and function in LVNC patients.
Cox regression analyses were used to determine the association of indexed RV end-diastolic area (RV-EDAI), indexed end-diastolic diameter (RV-EDDI), fractional area change (FAC), and tricuspid annular systolic excursion (TAPSE) with the occurrence of death or heart transplantation (composite endpoint).
Out of 127 patients (53.2 ± 17.8 years; 61% males, median follow-up time was 7.7 years), 17 patients reached the endpoint. In a univariate analysis, RV-EDAI was the strongest predictor of outcome [HR 1.48 (1.24-1.77) per cm/m; p < 0.0001]. FAC was predictive as well [HR 1.44 (1.16-1.83) per 5% decrease; p = 0.0009], while TAPSE was not (p=ns). RV-EDAI remained an independent predictor in a bivariable analysis with indexed left ventricular ED volume [HR 1.41 (1.18-1.70) per cm/m; p = 0.0002], while analysis of FAC and left ventricular ejection fraction demonstrated that FAC was not independent [HR 1.20 (0.98-1.52); per 5% decrease; p = 0.0721]. RV-EDAI 11.5 cm/m was the best cut-off value for separating patients in terms of outcome. Patients with RV-EDAI >11.5 cm/m had a survival rate of 18.5% over 12 years as compared to 93.8% in patients with RV-EDAI <11.5 cm/m (p < 0.0001).
Increased end-diastolic RV size and decreased systolic RV function are predictors of adverse outcome in patients with LVNC. Patients with RV-EDAI >11.5 cm/m exhibit a significantly lower survival than those <11.5 cm/m.
左心室心肌致密化不全（LVNC）患者发生不良事件的风险很大。然而，关于预后因素的信息有限。本研究旨在评估右心室（RV）大小和功能对 LVNC 患者的预后价值。
采用 Cox 回归分析确定 RV 舒张末期面积指数（RV-EDAI）、RV 舒张末期直径指数（RV-EDDI）、分数面积变化（FAC）和三尖瓣环收缩期位移（TAPSE）与死亡或心脏移植（复合终点）发生的相关性。
在 127 例患者（53.2±17.8 岁；61%为男性）中，中位随访时间为 7.7 年，17 例患者达到终点。在单变量分析中，RV-EDAI 是最强的预后预测因子[每增加 1cm/m 的 HR 为 1.48（1.24-1.77）；p<0.0001]。FAC 也是预测因子[每降低 5%的 HR 为 1.44（1.16-1.83）；p=0.0009]，而 TAPSE 则不是（p=ns）。在包含左心室 ED 容积指数的双变量分析中，RV-EDAI 仍然是一个独立的预测因子[每增加 1cm/m 的 HR 为 1.41（1.18-1.70）；p=0.0002]，而 FAC 和左心室射血分数的分析表明，FAC 不是独立的[每降低 5%的 HR 为 1.20（0.98-1.52）；p=0.0721]。RV-EDAI 为 11.5cm/m 是区分患者预后的最佳截断值。RV-EDAI>11.5cm/m 的患者 12 年的生存率为 18.5%，而 RV-EDAI<11.5cm/m 的患者生存率为 93.8%（p<0.0001）。
RV 舒张末期增大和收缩末期功能下降是 LVNC 患者不良预后的预测因子。RV-EDAI>11.5cm/m 的患者生存率明显低于 RV-EDAI<11.5cm/m 的患者。
