Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia.
School of Biomedical Engineering, The University of Sydney, Australia.
Int J Cardiol. 2021 Apr 1;328:235-240. doi: 10.1016/j.ijcard.2020.12.017. Epub 2020 Dec 11.
Left ventricular non-compaction (LVNC) is a complex clinical condition with several diagnostic criteria but no diagnostic gold standard. We aimed to evaluate our thresholding technique in a group of patients with LVNC and assess the risk of major adverse cardiovascular and cerebrovascular events (MACCE).
We retrospectively analyzed cardiac magnetic resonance (CMR) scans of patients with Petersen criteria LVNC and quantified noncompacted myocardial mass. We assessed the association of noncompacted myocardial mass, CMR derived LV volumetric parameters and late gadolinium enhancement (LGE) to MACCE including cardiac death, cardiac transplantation, sustained ventricular tachycardia/ventricular fibrillation (VT/VF) and ischemic stroke. Patients with known genetic mutations and cardiovascular disease were excluded.
98 patients with LVNC were included (55 males,56.7%); 17(17.3%) patients had impaired LV function and five (5.1%) had LGE. Patients with impaired LV function had more end-systolic noncompacted mass (61.9 g±22.4 vs. 38.1 g±15.8, p < 0.001) and larger end-systolic noncompacted to total myocardial mass (44%±9 vs. 36%±12, p = 0.003). At 78 months follow-up [interquartile range(IQR) 66-90], MACCE occurred in 11(11.3%) patients; nine(81.8%) had impaired LV function and two(18.2%) had LGE. Impaired LV function and LV LGE were predictors of MACCE (HR = 35.6, 95% CI = 7.65-165.21, p < 0.001 and HR = 16.2, 95% CI = 4.54-57.84, p < 0.001) whereas noncompacted mass were not.
Noncompacted mass was not an independent predictor of major adverse events but in patients with impaired LV function and/or LV LGE, the risk of MACCE was high. These results highlight the importance of including LV volumetrics and scar in the assessment of patients with LV noncompaction.
左心室心肌致密化不全（LVNC）是一种具有多种诊断标准但无诊断金标准的复杂临床病症。我们旨在评估我们的 LVNC 患者分组中的阈值技术，并评估主要不良心血管和脑血管事件（MACCE）的风险。
我们回顾性分析了符合 Petersen 标准的 LVNC 患者的心脏磁共振（CMR）扫描，并对非致密心肌质量进行了量化。我们评估了非致密心肌质量、CMR 衍生的 LV 容积参数和晚期钆增强（LGE）与 MACCE（包括心脏死亡、心脏移植、持续性室性心动过速/室颤（VT/VF）和缺血性卒中）之间的相关性。排除了已知遗传突变和心血管疾病的患者。
共纳入 98 例 LVNC 患者（55 名男性，56.7%）；17 例（17.3%）患者左室功能受损，5 例（5.1%）患者有 LGE。左室功能受损患者的收缩末期非致密心肌质量更大（61.9g±22.4 比 38.1g±15.8，p<0.001），收缩末期非致密心肌与总心肌质量的比值也更大（44%±9 比 36%±12，p=0.003）。在 78 个月的随访期间[四分位间距（IQR）66-90]，11 例（11.3%）患者发生 MACCE；9 例（81.8%）患者左室功能受损，2 例（18.2%）患者有 LGE。左室功能受损和 LV LGE 是 MACCE 的预测因素（HR=35.6，95%CI=7.65-165.21，p<0.001 和 HR=16.2，95%CI=4.54-57.84，p<0.001），而非致密心肌质量则不是。
非致密心肌质量不是主要不良事件的独立预测因素，但在左室功能受损和/或 LV LGE 的患者中，MACCE 的风险很高。这些结果强调了在评估 LV 非致密化患者时纳入 LV 容积参数和瘢痕的重要性。
