Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany.
J Cardiovasc Magn Reson. 2021 Dec 2;23(1):136. doi: 10.1186/s12968-021-00829-x.
Data on the prognostic value of left ventricular (LV) morphological and functional parameters including LV rotation in patients with dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance (CMR) are currently scarce. In this study, we assessed the prognostic value of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and LV torsion using CMR feature tracking (FT).
CMR was performed in 350 DCM patients and 70 healthy subjects across 5 different European CMR Centers. Myocardial strain parameters were retrospectively assessed from conventional balanced steady-state free precession cine images applying FT. A combined primary endpoint (cardiac death, heart transplantation, aborted sudden cardiac death) was defined for the assessment of clinical outcome.
GLS, GCS, GRS and LV torsion were significantly lower in DCM patients than in healthy subjects (all p < 0.001). The primary endpoint occurred in 59 (18.7%) patients [median follow-up 4.2 (2.0-5.6) years]. In the univariate analyses all strain parameters showed a significant prognostic value (p < 0.05). In the multivariate model, LV strain parameters, particularly GLS provided an incremental prognostic value compared to established CMR parameters like LV ejection fraction and late gadolinium enhancement. A scoring model including six categorical variables of standard CMR and strain parameters differentiated further risk subgroups.
LV strain assessed with CMR FT has a high prognostic value in patients with DCM, surpassing routine and dedicated functional parameters. Thus, CMR strain imaging may contribute to the improvement of risk stratification in DCM.
目前，使用心血管磁共振（CMR）评估扩张型心肌病（DCM）患者左心室（LV）形态和功能参数（包括 LV 扭转）的预后价值的数据很少。在这项研究中，我们使用 CMR 特征追踪（FT）评估了整体纵向应变（GLS）、整体周向应变（GCS）、整体径向应变（GRS）和 LV 扭转的预后价值。
在 5 个不同的欧洲 CMR 中心，对 350 名 DCM 患者和 70 名健康受试者进行了 CMR 检查。从常规平衡稳态自由进动电影图像应用 FT 回顾性评估心肌应变参数。定义了一个联合的主要终点（心脏死亡、心脏移植、心脏性猝死中止）来评估临床结果。
与健康受试者相比，DCM 患者的 GLS、GCS、GRS 和 LV 扭转明显降低（均 P<0.001）。主要终点发生在 59 例（18.7%）患者中[中位随访时间为 4.2（2.0-5.6）年]。在单变量分析中，所有应变参数均具有显著的预后价值（P<0.05）。在多变量模型中，LV 应变参数，特别是 GLS，与 LV 射血分数和晚期钆增强等既定 CMR 参数相比，提供了额外的预后价值。包括标准 CMR 和应变参数六个分类变量的评分模型进一步区分了风险亚组。
CMR FT 评估的 LV 应变在 DCM 患者中有很高的预后价值，超过了常规和专用功能参数。因此，CMR 应变成像可能有助于改善 DCM 的风险分层。
