Cojan-Minzat Bianca Olivia, Zlibut Alexandru, Muresan Ioana Danuta, Orzan Rares-Ilie, Cionca Carmen, Horvat Dalma, David Liliana, Visan Alexandru Ciprian, Florea Mira, Agoston-Coldea Lucia
Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Biomedicines. 2021 Nov 10;9(11):1653. doi: 10.3390/biomedicines9111653.
Left atrial (LA) geometry and phasic functions are frequently impaired in non-ischaemic dilated cardiomyopathy (NIDCM). Cardiac magnetic resonance (CMR) can accurately measure LA function and geometry parameters. We sought to investigate their prognostic role in patients with NIDCM. We prospectively examined 212 patients with NIDCM (49 ± 14.2-year-old; 73.5% males) and 106 healthy controls. LA volumes, phasic functions, geometry, and fibrosis were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, heart failure hospitalization) was ascertained over a median of 26 months. LA phasic functions, sphericity index (LASI) and late gadolinium enhancement (LA-LGE) were considerably impaired in the diseased group ( < 0.001) and significantly correlated with impaired LV function parameters ( < 0.0001). After multivariate analysis, LA volumes, LASI, LA total strain (LA-ε) and LA-LGE were associated with increased risk of composite outcome ( < 0.001). Kaplan-Meier analysis showed significantly higher risk of composite endpoint for LA volumes (all < 0.01), LASI > 0.725 ( < 0.003), and LA-ε < 30% ( < 0.0001). Stepwise Cox proportional-hazards models demonstrated a considerable incremental predictive value which resulted by adding LASI to LA-ε (Chi-square = 10.2, < 0.001), and afterwards LA-LGE (Chi-Square = 15.8; < 0.0001). NIDCM patients with defective LA volumes, LASI, LA-LGE and LA-ε had a higher risk for an outcome. LA-ε, LASI and LA-LGE provided independent incremental predictive value for outcome.
在非缺血性扩张型心肌病（NIDCM）中，左心房（LA）的几何形态和阶段性功能常常受损。心脏磁共振成像（CMR）能够准确测量LA功能和几何形态参数。我们旨在研究它们在NIDCM患者中的预后作用。我们前瞻性地检查了212例NIDCM患者（年龄49±14.2岁；男性占73.5%）和106名健康对照者。使用CMR测定LA容积、阶段性功能、几何形态和纤维化情况。在中位时间26个月内确定了一个复合结局（心源性死亡、室性快速心律失常、心力衰竭住院）。患病组的LA阶段性功能、球形指数（LASI）和延迟钆增强（LA-LGE）明显受损（<0.001），并且与左心室功能参数受损显著相关（<0.0001）。多变量分析后，LA容积、LASI、LA总应变（LA-ε）和LA-LGE与复合结局风险增加相关（<0.001）。Kaplan-Meier分析显示，LA容积（均<0.01）、LASI>0.725（<0.003）和LA-ε<30%（<0.0001）的复合终点风险显著更高。逐步Cox比例风险模型显示，将LASI添加到LA-ε后（卡方=10.2，<0.001），以及随后添加LA-LGE（卡方=15.8；<0.0001），具有相当大的增量预测价值。LA容积、LASI、LA-LGE和LA-ε存在缺陷的NIDCM患者发生结局的风险更高。LA-ε、LASI和LA-LGE为结局提供了独立的增量预测价值。
