Gastl Mareike, Gruner Christiane, Labucay Karin, Gotschy Alexander, Von Spiczak Jochen, Polacin Malgorzata, Boenner Florian, Kelm Malte, Ruschitzka Frank, Alkadhi Hatem, Kozerke Sebastian, Manka Robert
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
Open Heart. 2020 Mar 15;7(1):e001152. doi: 10.1136/openhrt-2019-001152. eCollection 2020.
Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of adverse cardiac events. Beyond classic risk factors, relative myocardial ischaemia and succeeding myocardial alterations, which can be detected using either contrast agents or parametric mapping in cardiovascular magnetic resonance (CMR) imaging, have shown an impact on outcome in HCM. CMR may help to risk stratify using parametric T2* mapping. Therefore, the aim of the present study was to evaluate the association of T2* values or fibrosis with cardiovascular events in HCM.
The relationship between T2* with supraventricular, ventricular arrhythmia or heart failure was retrospectively assessed in 91 patients with HCM referred for CMR on a 1.5T MR imaging system. Fibrosis as a reference was added to the model. Patients were subdivided into groups according to T2* value quartiles.
47 patients experienced an event of ventricular arrhythmia, 25 of atrial fibrillation/flutter and 17 of heart failure. T2*≤28.7 ms yielded no association with ventricular events in the whole HCM cohort. T2* of non-obstructive HCM showed a significant association with ventricular events in univariate analysis, but not in multivariate analysis. For the combined endpoint of arrhythmic events, there was already an association for the whole HCM cohort, but again only in univariate analyses. Fibrosis stayed the strongest predictor in all analyses. There was no association for T2* and fibrosis with heart failure.
Decreased T2* values by CMR only provide a small association with arrhythmic events in HCM, especially in non-obstructive HCM. No information is added for heart failure.
肥厚型心肌病（HCM）与不良心脏事件风险增加相关。除了经典危险因素外，相对心肌缺血及随后的心肌改变，可通过心血管磁共振（CMR）成像中的造影剂或参数成像检测到，已显示对HCM的预后有影响。CMR可通过参数T2成像有助于进行危险分层。因此，本研究的目的是评估HCM中T2值或纤维化与心血管事件的关联。
回顾性评估了91例因CMR检查而转诊至1.5T MR成像系统的HCM患者中，T2与室上性、室性心律失常或心力衰竭之间的关系。将纤维化作为参考因素纳入模型。根据T2值四分位数将患者分为不同组。
47例患者发生室性心律失常事件，25例发生心房颤动/扑动，17例发生心力衰竭。在整个HCM队列中，T2*≤28.7 ms与室性事件无关联。在单因素分析中，非梗阻性HCM的T2与室性事件显著相关，但在多因素分析中并非如此。对于心律失常事件的联合终点，在整个HCM队列中已经存在关联，但同样仅在单因素分析中。在所有分析中，纤维化仍然是最强的预测因素。T2和纤维化与心力衰竭无关联。
CMR检测到的T2*值降低仅与HCM中的心律失常事件有较小关联，尤其是在非梗阻性HCM中。对于心力衰竭未提供额外信息。
