心脏磁共振特征追踪技术评估心脏移植术后的整体纵向应变及其预后。
Cardiac Magnetic Resonance Feature Tracking Global Longitudinal Strain and Prognosis After Heart Transplantation.
机构信息
Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
Department of Medicine, University of Verona, Verona, Italy.
出版信息
JACC Cardiovasc Imaging. 2020 Sep;13(9):1934-1942. doi: 10.1016/j.jcmg.2020.04.004. Epub 2020 Jun 17.
OBJECTIVES
This study determined the long-term prognostic significance of GLS assessed using CMR-FT in a large cohort of heart transplant recipients.
BACKGROUND
In heart transplant recipients, global longitudinal strain (GLS) assessed using echocardiography has shown promise in the prediction of clinical outcomes. We hypothesized that CMR feature tracking (CMR-FT) GLS is independently associated with long-term outcomes in heart transplant recipients.
METHODS
In a cohort of consecutive heart transplant recipients who underwent routine CMR for clinical surveillance, CMR-FT GLS was calculated from 3 long-axis cine CMR images. Associations between GLS and a composite endpoint of death or major adverse cardiac events (MACE), including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization, were investigated.
RESULTS
A total of 152 heart transplant recipients (age 54 ± 15 years; 29% women; 5.0 ± 5.4 years after heart transplantation) were included. The median GLS was -11.6% (interquartile range: -13.6% to -9.2%). Over a median follow-up of 2.6 years, 59 recipients reached the composite endpoint. On Kaplan-Meier analyses, recipients with GLS worse than the median had a higher estimated cumulative incidence of the composite endpoint compared with recipients with GLS better than the median (log rank p = 0.004). On multivariate Cox proportional hazards regression, GLS was independently associated with the composite endpoint after adjustment for cardiac allograft vasculopathy, history of rejection, left ventricular ejection fraction (LVEF), right ventricular EF, and presence of myocardial fibrosis, with a hazard ratio of 1.15 for every 1% worsening in GLS (95% confidence interval: 1.06 to 1.24; p < 0.001). Similar results were seen in subgroups of recipients with LVEF >50% and with no myocardial fibrosis. GLS provided incremental prognostic value over other variables in the multivariate model as determined by the log-likelihood chi-squared test.
CONCLUSIONS
In a large cohort of heart transplant recipients, CMR-FT GLS was independently associated with the long-term risk of death or MACE.
目的
本研究旨在通过大样本心脏移植受者队列，评估心脏磁共振（CMR）-FT 技术测量的整体纵向应变（GLS）的长期预后意义。
背景
在心脏移植受者中，超声心动图评估的 GLS 已显示出对临床结局预测的潜力。我们假设 CMR 斑点追踪（CMR-FT）GLS 与心脏移植受者的长期结局独立相关。
方法
在接受常规 CMR 进行临床监测的连续心脏移植受者队列中，从 3 个长轴电影 CMR 图像计算 CMR-FT GLS。研究 GLS 与死亡或主要不良心脏事件（MACE）复合终点（包括再次移植、非致命性心肌梗死、冠状动脉血运重建和心力衰竭住院）之间的相关性。
结果
共纳入 152 例心脏移植受者（年龄 54 ± 15 岁；29%为女性；心脏移植后 5.0 ± 5.4 年）。中位 GLS 为-11.6%（四分位距：-13.6%-9.2%）。中位随访 2.6 年后，59 例受者达到复合终点。在 Kaplan-Meier 分析中，GLS 低于中位数的受者发生复合终点的估计累积发生率高于 GLS 高于中位数的受者（对数秩检验 p = 0.004）。在多变量 Cox 比例风险回归中，在校正心脏移植物血管病、排斥史、左心室射血分数（LVEF）、右心室 EF 和心肌纤维化存在后，GLS 与复合终点独立相关，GLS 每恶化 1%，风险比为 1.15（95%置信区间：1.061.24；p < 0.001）。在 LVEF >50%和无心肌纤维化的受者亚组中也观察到了类似的结果。GLS 通过对数似然卡方检验确定，在多变量模型中提供了比其他变量更高的增量预后价值。
结论
在一个大的心脏移植受者队列中，CMR-FT GLS 与死亡或 MACE 的长期风险独立相关。
Zotero 插件