Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary.
Int J Cardiovasc Imaging. 2021 Jun;37(6):2027-2036. doi: 10.1007/s10554-021-02165-8. Epub 2021 Feb 8.
The prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.
肥厚型心肌病（HCM）患者的预后差异很大。心脏磁共振（CMR）是评估左心室（LV）质量和容积的金标准方法。CMR 可无创检测心肌纤维化。此外，特征追踪（FT）应变分析可提供 LV 变形的信息。我们旨在研究 HCM 患者标准 CMR 参数、心肌纤维化和 LV 应变参数的预后意义。我们研究了 187 名接受 CMR 检查并伴有延迟钆增强的 HCM 患者，并对其进行了随访。LV 质量（LVM）通过排除和包含小梁和乳头肌（TPM）进行评估。计算整体 LV 应变参数和机械弥散（MD）。定量心肌纤维化。我们研究的复合终点是全因死亡率、心脏移植、恶性室性心律失常和适当的植入式心脏复律除颤器（ICD）治疗。心律失常终点为恶性室性心律失常和适当的 ICD 治疗。LVMi 是独立于定量方法的复合终点的独立 CMR 预测因子（p<0.01）。复合终点的单变量预测因子包括 LVMi、整体纵向（GLS）和径向应变以及纵向 MD（MDL）。心律失常事件的单变量预测因子包括 LVMi 和心肌纤维化。更明显的 LV 肥厚与 GLS 受损和 MDL 增加相关。更广泛的心肌纤维化与 GLS 受损相关（p<0.001）。LVMi 是 HCM 患者主要事件的独立 CMR 预测因子，心肌纤维化预测心律失常事件。FT 应变分析为 HCM 患者的风险分层提供了额外的信息。
