非缺血性扩张型心肌病中冠状动脉粥样硬化负担的预后
Prognosis of Coronary Atherosclerotic Burden in Non-Ischemic Dilated Cardiomyopathies.
作者信息
Canu Marjorie, Margerit Léa, Mekhdoul Ismail, Broisat Alexis, Riou Laurent, Djaileb Loïc, Charlon Clémence, Jankowski Adrien, Magnesa Michele, Augier Caroline, Marlière Stéphanie, Salvat Muriel, Casset Charlotte, Maurin Marion, Saunier Carole, Fagret Daniel, Ghezzi Catherine, Vanzetto Gerald, Barone-Rochette Gilles
机构信息
Department of Cardiology, University Hospital, 38000 Grenoble Alpes, France.
INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble Alpes University, 38000 Grenoble Alpes, France.
出版信息
J Clin Med. 2021 May 18;10(10):2183. doi: 10.3390/jcm10102183.
BACKGROUND
Atherosclerosis is associated with a worse prognosis in many diseases such as ischemic cardiomyopathy, but its impact in non-ischemic dilated cardiomyopathy (dCMP) is lesser known. Our aim was to study the prognostic impact of coronary atherosclerotic burden (CAB) in patients with dCMP.
METHODS
Consecutive patients with dCMP and left ventricular (LV) dysfunction diagnosed by concomitant analysis of invasive coronary angiography (ICA) and CMR imaging were identified from registry-database. CAB was measured by Gensini score. The primary composite endpoint was the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular (CV) mortality, non-fatal MI and unplanned myocardial revascularization. The results of 139 patients constituting the prospective study population (mean age 59.4 ± 14.7 years old, 74% male), average LV ejection fraction was 31.1 ± 11.02%, median Gensini score was 0 (0-3), and mid-wall late gadolinium enhancement (LGE) was the most frequent LGE pattern (42%). Over a median follow-up of 2.8 years, 9% of patients presented MACE. Patients with MACE had significantly higher CAB compared to those who were free of events (0 (0-3) vs. 3.75 (2-15), < 0.0001). CAB remained the significant predictor of MACE on multivariate logistic analysis (OR: 1.12, CI: 1.01-1.23, = 0.02).
CONCLUSION
High CAB may be a new prognostic factor in dCMP patients.
背景
动脉粥样硬化与许多疾病（如缺血性心肌病）的预后较差有关，但其在非缺血性扩张型心肌病（dCMP）中的影响鲜为人知。我们的目的是研究冠状动脉粥样硬化负担（CAB）对dCMP患者的预后影响。
方法
从登记数据库中识别出通过有创冠状动脉造影（ICA）和心脏磁共振成像（CMR）同步分析诊断为dCMP和左心室（LV）功能障碍的连续患者。CAB通过Gensini评分测量。主要复合终点是发生主要不良心血管事件（MACE），定义为心血管（CV）死亡、非致命性心肌梗死和计划外心肌血运重建。前瞻性研究人群由139例患者组成（平均年龄59.4±14.7岁，74%为男性），平均左心室射血分数为31.1±11.02%，Gensini评分中位数为0（0 - 3），中层心肌晚期钆增强（LGE）是最常见的LGE模式（42%）。在中位随访2.8年期间，9%的患者出现MACE。与无事件患者相比，发生MACE的患者CAB显著更高（0（0 - 3）对3.75（2 - 15），<0.0001）。在多因素逻辑分析中，CAB仍然是MACE的显著预测因子（OR：1.12，CI：1.01 - 1.23， = 0.02）。
结论
高CAB可能是dCMP患者的一个新的预后因素。
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