MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi 1, 56124, Pisa, Italy.
Department of Cardiology, Policlinico "P. Giaccone", Palermo, Italy.
Eur Radiol. 2021 Oct;31(10):7553-7565. doi: 10.1007/s00330-021-07875-0. Epub 2021 Apr 5.
Although cardiovascular magnetic resonance (CMR) is widely used in the assessment of left ventricular non-compaction (LVNC), there are no universally accepted diagnostic criteria and limited data regarding their prognostic value. We assessed the long-term prognostic role of the planimetric global Grothoff's criteria and of the CMR findings in predicting adverse cardiovascular events (CE).
We prospectively enrolled 78 patients (46.7 ± 18.7 years, 33.3% females) with documented positive Jenni's echocardiographic criteria for LVNC. Cine images were used to quantify function parameters and to assess for the presence of all four quantitative Grothoff's criteria (global Grothoff's criteria). Late gadolinium enhancement (LGE) images were acquired to detect the presence of replacement myocardial fibrosis.
Petersen's CMR criterion for LVNC (NC/C ratio > 2.3 in at least one myocardial segment) was fulfilled in the whole population. Twenty-six patients fulfilled the global Grothoff's criteria (four out of four). The mean duration of the follow-up was 44.2 ± 27.4 months and 28 CE were registered: 10 ventricular tachycardias, 12 episodes of heart failure (HF), four strokes, and two cardiac deaths. In the multivariate analysis, the independent predictive factors for CE were positive global Grothoff's criteria (hazard ratio, HR = 3.33, 95% CI = 1.52-7.29; p = 0.003) and myocardial fibrosis (HR = 2.41, 95% CI = 1.08-5.36; p = 0.032).
Positive global Grothoff's criteria and myocardial fibrosis were powerful predictors of CE in patients with a diagnosis of LVNC by CMR Petersen's criterion. Thus, we strongly suggest a step approach confirming the diagnosis of LVNC by using the global planimetric Grothoff's criteria, which showed a prognostic impact.
• Positive global Grothoff's criteria and replacement myocardial fibrosis were powerful predictors of cardiovascular events in patients with a diagnosis of LVNC by CMR Petersen's criterion. • Positive global Grothoff's criteria were associated with a higher frequency of ventricular arrhythmias in patients with a diagnosis of LVNC by CMR Petersen's criterion.
尽管心血管磁共振（CMR）广泛用于评估左心室心肌致密化不全（LVNC），但目前尚无普遍接受的诊断标准，并且关于其预后价值的数据也有限。我们评估了平面整体 Grothoff 标准和 CMR 检查结果对不良心血管事件（CE）的长期预测作用。
我们前瞻性纳入 78 例（年龄 46.7 ± 18.7 岁，女性占 33.3%）经超声心动图 Jenni 标准确诊为 LVNC 的患者。使用电影图像来量化功能参数，并评估是否存在全部 4 项定量 Grothoff 标准（整体 Grothoff 标准）。获取钆延迟增强（LGE）图像以检测是否存在替换性心肌纤维化。
整个研究人群均满足 Petersen 的 CMR 诊断 LVNC 的标准（至少一个心肌节段的 NC/C 比值＞2.3）。26 例患者符合整体 Grothoff 标准（4 项均符合）。平均随访时间为 44.2 ± 27.4 个月，共记录到 28 例 CE：10 例室性心动过速，12 例心力衰竭（HF），4 例中风和 2 例心脏性死亡。多变量分析显示，CE 的独立预测因素为阳性整体 Grothoff 标准（危险比，HR=3.33，95%置信区间=1.52-7.29；p=0.003）和心肌纤维化（HR=2.41，95%置信区间=1.08-5.36；p=0.032）。
在经 CMR Petersen 标准诊断为 LVNC 的患者中，阳性整体 Grothoff 标准和心肌纤维化是 CE 的有力预测因素。因此，我们强烈建议采用一种逐步方法来确认 LVNC 的诊断，使用整体平面 Grothoff 标准可以得出预后结果。
经 CMR Petersen 标准诊断为 LVNC 的患者中，阳性整体 Grothoff 标准和替换性心肌纤维化是心血管事件的有力预测因素。
经 CMR Petersen 标准诊断为 LVNC 的患者中，阳性整体 Grothoff 标准与室性心律失常的发生率更高相关。
