心脏 MRI 晚期钆增强在中重度左心室功能障碍心力衰竭患者危险分层中的增量价值。

Incremental value of Late Gadolinium Enhancement by Cardiac MRI in risk stratification of heart failure patients with moderate and severe LV dysfunction.

机构信息

Department of Cardiology, KIMS Hospitals, Hyderabad, India.

Department of Radiology, KIMS Hospitals, Hyderabad, India.

出版信息

Indian Heart J. 2021 Jan-Feb;73(1):49-55. doi: 10.1016/j.ihj.2020.11.150. Epub 2020 Nov 24.

OBJECTIVE

This is a prospective study of patients with LVEF ≤40%, with the objective of correlating CV events to LGE detected and quantified by CMRI.

METHODS

Heart Failure (HF) patients with LVEF <40% who underwent CMRI were included. LGE volume of ≥6% of the myocardial volume was considered significant. Data of appropriate ICD shocks, CV hospitalizations and mortality were recorded.

RESULTS

There were 133 HF (72 ICM & 62 NIDCM) patients with a mean age of 54 ± 12 years, mean LVEF of 34 ± 6% and a follow up of 24 ± 3 months. Totally 46 CV events were recorded in 30 patients, 44 in LGE +ve & 2 in LGE -ve groups (HR 17.8, 95% CI-8.03-39.3, P = 0.000095). All the 7 deaths were in LGE +ve group. CV events were 22 (30.5%) in ICM group and 8 (13.1%) in NIDCM group (p = 0.03). All the 22 ICM patients and 6 of the 8 NIDCM with CV events were LGE +ve. The distribution of CV events amongst LGE +ve and LGE -ve were 35 vs 0 (ICM) and 9 vs 2 (NIDCM); p < 0.005.CV events in LVEF ≤ 30% group, were seen in 19 (47.5%) vs 1 (5.8%) in LGE +ve vs LGE -ve and no of events were 29 vs 1 (p = 0.003). In those with LVEF >30% the corresponding figures were 9 (22.5%) vs 1 (2.8%) and 15 vs 1 respectively (p = 0.02).

CONCLUSION

Demonstration of significant LGE by CMRI indicates high risk occurrence of CV events (CV hospitalization, appropriate shocks and total mortality) in NIDCM & ICM patients with LVEF < 40%.

目的

本研究前瞻性纳入左心室射血分数（LVEF）≤40%的患者，旨在通过心脏磁共振成像（CMRI）检测和量化延迟钆增强（LGE），并将其与心血管（CV）事件相关联。

方法

纳入 LVEF＜40%且接受 CMRI 检查的心力衰竭（HF）患者。将心肌容积 LGE 体积≥6%定义为显著 LGE。记录适当的 ICD 电击、CV 住院和死亡率等数据。

结果

共纳入 133 例 HF（72 例特发性扩张型心肌病[ICM]和 62 例非特发性扩张型心肌病[NIDCM]）患者，平均年龄 54±12 岁，平均 LVEF 为 34±6%，随访时间为 24±3 个月。30 例患者共记录到 46 例 CV 事件，其中 LGE+ve 组 44 例，LGE-ve 组 2 例（HR 17.8，95%CI-8.03-39.3，P=0.000095）。LGE+ve 组中有 7 例死亡。ICM 组中 22 例（30.5%）和 NIDCM 组中 8 例（13.1%）发生 CV 事件（p=0.03）。ICM 组和 NIDCM 组中所有 22 例 ICM 患者和 6 例 NIDCM 患者的 CV 事件均为 LGE+ve。LGE+ve 组和 LGE-ve 组的 CV 事件发生率分别为 35%和 0%（ICM）和 9%和 2%（NIDCM）（p＜0.05）。LVEF≤30%组中，LGE+ve 组有 19 例（47.5%）发生 CV 事件，而 LGE-ve 组仅 1 例（5.8%）发生，相应 CV 事件分别为 29 例和 1 例（p=0.003）。在 LVEF＞30%的患者中，相应的 CV 事件发生率分别为 9 例（22.5%）和 1 例（2.8%），CV 事件分别为 15 例和 1 例（p=0.02）。