From the Departments of Cardiology (Y.L., Y.X., S.T., X.J., W.L., J.G., F.Y., Z.X., Y.C.) and Radiology (J.S.), West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.); and Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Guangdong, China (Y.Z.).
Radiology. 2022 Jan;302(1):72-81. doi: 10.1148/radiol.2021210801. Epub 2021 Oct 26.
Background There is increasing recognition that left atrial (LA) function is prognostically important in cardiovascular disease. LA strain is a sensitive parameter to describe complex LA phasic function. However, the prognostic value of LA strain in participants with idiopathic dilated cardiomyopathy (DCM) remains unclear. Purpose To evaluate the prognostic value of LA strain derived from cardiac MRI in study participants with idiopathic DCM. Materials and Methods Participants with idiopathic DCM who underwent cardiac MRI between June 2012 and November 2018 were prospectively enrolled. The fast long-axis strain MRI method was performed to assess LA strain. The primary end point was all-cause mortality and heart transplant, and the secondary end point was a combination of primary end point, heart failure readmission, and aborted sudden cardiac death. Cox regression analyses and Kaplan-Meier survival analysis were performed to identify the association between variables and outcomes. Results There were 497 participants (mean age, 47 years ± 14 [standard deviation]; 357 men) evaluated. During a median follow-up of 36 months (interquartile range, 26-54 months), 113 participants reached primary end points and 203 participants reached secondary end points. LA reservoir, conduit and booster strain, and strain rate were lower in participants with primary end points ( < .001). In multivariable Cox regression analysis, LA reservoir strain and conduit strain were independent predictors for primary end point (hazard ratio [HR] per 1% increase, 0.95 [95% CI: 0.91, 0.99; = .008] and 0.92 [95% CI: 0.87, 0.98; = .010], respectively) and secondary end points (HR per 1% increase, 0.95 [95% CI: 0.93, 0.97; < .001] and 0.93 [95% CI: 0.89, 0.97; < .001], respectively). In addition, LA reservoir strain and conduit strain added incremental prognostic value to clinical risk factors and late gadolinium enhancement presence (all, < .05). Conclusion Left atrial reservoir and conduit strain, derived from cardiac MRI by using the fast long-axis method, were independent predictors of adverse clinical outcomes in idiopathic dilated cardiomyopathy. © RSNA, 2021 See also the editorial by Ambale-Venkatesh in this issue.
越来越多的人认识到左心房（LA）功能在心血管疾病中的预后重要性。LA 应变是描述复杂 LA 时相功能的敏感参数。然而，LA 应变在特发性扩张型心肌病（DCM）患者中的预后价值尚不清楚。目的：评估心脏 MRI 衍生的 LA 应变在特发性 DCM 患者中的预后价值。材料与方法：前瞻性纳入 2012 年 6 月至 2018 年 11 月接受心脏 MRI 的特发性 DCM 患者。采用快速长轴应变 MRI 方法评估 LA 应变。主要终点为全因死亡率和心脏移植，次要终点为主要终点、心力衰竭再入院和心脏性猝死未遂的组合。进行 Cox 回归分析和 Kaplan-Meier 生存分析，以确定变量与结局之间的关联。结果：共评估了 497 名患者（平均年龄，47 岁±14[标准差]；357 名男性）。中位随访 36 个月（四分位距，26-54 个月）期间，113 名患者达到主要终点，203 名患者达到次要终点。主要终点患者的 LA 储备、输送和增强应变及应变率较低（<.001）。多变量 Cox 回归分析显示，LA 储备应变和输送应变是主要终点的独立预测因子（每增加 1%的危险比[HR]，0.95[95%CI：0.91，0.99；=.008]和 0.92[95%CI：0.87，0.98；=.010]）和次要终点（每增加 1%的 HR，0.95[95%CI：0.93，0.97；<.001]和 0.93[95%CI：0.89，0.97；<.001]）。此外，LA 储备应变和输送应变增加了临床危险因素和晚期钆增强存在的附加预后价值（均<.05）。结论：通过快速长轴方法从心脏 MRI 获得的 LA 储备和输送应变是特发性扩张型心肌病不良临床结局的独立预测因子。
