Department of Cardiology, IIS-IP, La Princesa University Hospital, Madrid, Spain.
Department of Preventive Medicine, Clinico San Carlos University Hospital, Madrid, Spain.
Am J Cardiol. 2022 Jul 1;174:126-135. doi: 10.1016/j.amjcard.2022.03.024. Epub 2022 May 4.
Hypertrophic cardiomyopathy (HC) is the most common cardiovascular inherited disease, and it is associated with arrhythmic events, heart failure, and death. Strain analysis by tissue tracking (TT) techniques on cardiac magnetic resonance (CMR) is a novel noninvasive diagnostic tool. However, the usefulness of CMR-TT to identify patients with HC at risk of adverse outcomes remains unknown. CMR strain parameters by CMR-TT were prospectively measured in a cohort of 136 consecutive patients with HC. Clinical (death or readmission for heart failure) and arrhythmic (any ventricular tachycardia) events during follow-up were prospectively recorded. Global radial systolic strain rate and global radial diastolic strain rate showed the best area under the receiver operating characteristic curve (ROC curve) to predict adverse clinical events. On Cox multivariate regression models, a global radial systolic strain rate value <1.4/s and a global radial diastolic strain rate value ≥ -1.38/s were independently associated with clinical events at follow-up (adjusted hazard ratio 6.57, 95% confidence interval [CI] 2.01 to 21.49, p = 0.002; adjusted hazard ratio 5.96, 95% CI 1.79 to 19.89, p = 0.004, respectively). Regarding arrhythmic events, global radial peak strain <27% showed the best area under the ROC curve and remained independently associated with ventricular tachycardia after adjustment for confounders (odds ratio 7.33, 95% CI 1.07 to 50.41, p = 0.043). CMR strain parameters by TT predict clinical and arrhythmic events in patients with HC.
肥厚型心肌病 (HC) 是最常见的心血管遗传性疾病，与心律失常事件、心力衰竭和死亡有关。心脏磁共振 (CMR) 组织追踪 (TT) 技术的应变分析是一种新的无创诊断工具。然而，CMR-TT 识别有不良结局风险的 HC 患者的有用性尚不清楚。前瞻性测量了 136 例连续 HC 患者的 CMR-TT 心肌应变参数。前瞻性记录了随访期间的临床（死亡或因心力衰竭再入院）和心律失常（任何室性心动过速）事件。整体径向收缩期应变率和整体径向舒张期应变率显示出预测不良临床事件的最佳受试者工作特征曲线（ROC 曲线）下面积。在 Cox 多变量回归模型中，整体径向收缩期应变率值 <1.4/s 和整体径向舒张期应变率值≥-1.38/s 与随访时的临床事件独立相关（调整后的危险比 6.57，95%置信区间 [CI] 2.01 至 21.49，p=0.002；调整后的危险比 5.96，95% CI 1.79 至 19.89，p=0.004）。关于心律失常事件，整体径向收缩期峰值应变 <27% 显示出最佳的 ROC 曲线下面积，在调整混杂因素后仍与室性心动过速独立相关（比值比 7.33，95% CI 1.07 至 50.41，p=0.043）。TT 的 CMR 应变参数可预测 HC 患者的临床和心律失常事件。
