Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Department of Radiology, Iwate Medical University, 1-1, Idaidori, Yahaba, 028-3695, Iwate, Japan.
J Cardiovasc Magn Reson. 2021 Mar 25;23(1):32. doi: 10.1186/s12968-021-00734-3.
Non-ischemic cardiomyopathy (NICM) is a heterogeneous disease, and its prognosis varies. Although late gadolinium enhancement (LGE)-cardiovascular magnetic resonance (CMR) demonstrates a linear pattern in the mid-wall of the septum or multiple LGE lesions in patients with NICM, the therapeutic response and prognosis of multiple LGE lesions have not been elucidated. This study aimed to investigate the frequency of left ventricular (LV) reverse remodeling (LVRR) and prognosis in patients with NICM who have multiple LGE lesions.
This single-center retrospective study included 101 consecutive patients with NICM who were divided into 3 groups according to LGE-CMR results: patients without LGE (no LGE group = 48 patients), patients with a typical mid-wall LGE pattern (n = 29 patients), and patients with multiple LGE lesions (n = 24 patients). LVRR was defined as an increase in LV ejection fraction (LVEF) ≥ 10 % and a final value of LVEF > 35 %, which was accompanied by a decrease in LV end-systolic volume ≥ 15 % at 12-month follow-up using echocardiography. The frequency of composite cardiac events, defined as sudden cardiac death (SCD), aborted SCD (non-fatal ventricular fibrillation, sustained ventricular tachycardia, or adequate implantable cardioverter-defibrillator therapies), and heart failure death or hospitalization for worsening heart failure, were summarized and compared between the groups.
Among the 3 groups, the frequency of LVRR was significantly lower in the multiple lesions group than in the no LGE and mid-wall groups (no LGE vs. mid-wall vs. multiple lesions: 49 % vs. 52 % vs. 19 %, p = 0.03). There were 24 composite cardiac events among the patients: 2 in patients without LGE (hospitalization for worsening heart failure; 2), 7 in patients of the mid-wall group (SCD; 1, aborted SCD; 1 and hospitalization for worsening heart failure; 5), and 15 in patients of the multiple lesions group (SCD; 1, aborted SCD; 8 and hospitalization for worsening heart failure; 6). The multiple LGE lesions was an independent predictor of composite cardiac events (hazard ratio: 11.40 [95 % confidence intervals: 1.49-92.01], p = 0.020).
Patients with multiple LGE lesions have a higher risk of cardiac events and poorer LVRR. The LGE pattern may be useful for an improved risk stratification in patients with NICM.
非缺血性心肌病（NICM）是一种异质性疾病，其预后各不相同。尽管晚期钆增强（LGE）心血管磁共振（CMR）在 NICM 患者中显示出室间隔中壁的线性模式或多个 LGE 病变，但尚未阐明多个 LGE 病变的治疗反应和预后。本研究旨在探讨具有多个 LGE 病变的 NICM 患者左心室（LV）反向重构（LVRR）的频率和预后。
这是一项单中心回顾性研究，纳入了 101 例连续的 NICM 患者，根据 LGE-CMR 结果分为 3 组：无 LGE 患者（无 LGE 组=48 例）、具有典型中壁 LGE 模式的患者（n=29 例）和具有多个 LGE 病变的患者（n=24 例）。LVRR 定义为使用超声心动图在 12 个月随访时，LV 射血分数（LVEF）增加≥10%且最终 LVEF>35%，同时 LV 收缩末期容积减少≥15%。总结并比较了各组之间复合心脏事件（定义为心源性猝死（SCD）、非致命性室颤、持续性室性心动过速或适当的植入式心脏复律除颤器治疗）和心力衰竭死亡或因心力衰竭恶化而住院的频率。
在 3 组中，多个病变组的 LVRR 频率明显低于无 LGE 和中壁组（无 LGE 组比中壁组比多个病变组：49%比 52%比 19%，p=0.03）。24 例复合心脏事件患者：无 LGE 患者 2 例（因心力衰竭恶化住院；2），中壁组 7 例（SCD；1，非致命性室颤；1 和因心力衰竭恶化住院；5），多个病变组 15 例（SCD；1，非致命性室颤；8 和因心力衰竭恶化住院；6）。多个 LGE 病变是复合心脏事件的独立预测因子（危险比：11.40[95%置信区间：1.49-92.01]，p=0.020）。
多个 LGE 病变的患者发生心脏事件的风险更高，LVRR 更差。LGE 模式可能有助于改善 NICM 患者的风险分层。
