Di Marco Andrea, Brown Pamela F, Bradley Joshua, Nucifora Gaetano, Anguera Ignasi, Miller Christopher A, Schmitt Matthias
Department of Cardiology, Hospital Universitari de Bellvitge, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona 08907, Spain.
Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
Eur Heart J Cardiovasc Imaging. 2023 Mar 21;24(4):512-521. doi: 10.1093/ehjci/jeac142.
To evaluate whether cardiac magnetic resonance (CMR)-based parametric mapping and strain analysis can improve the risk-stratification for ventricular arrhythmias (VA) and sudden death (SD) in non-ischaemic cardiomyopathy (NICM).
Secondary analysis of a prospective single-centre-registry (NCT02326324), including 703 consecutive NICM patients, 618 with extracellular volume (ECV) available. The combined primary endpoint included appropriate implantable cardioverter defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. During a median follow-up of 21 months, 14 patients (2%) experienced the primary endpoint. Native T1 was not associated with the primary endpoint. Left ventricular global longitudinal strain lost its significant association after adjustment for left ventricular ejection fraction (LVEF). Among patients with ECV available, 11 (2%) reached the primary endpoint. Mean ECV was significantly associated with the primary endpoint and the best cut-off was 30%. ECV ≥ 30% was the strongest independent predictor of the primary endpoint (hazard ratio 14.1, P = 0.01) after adjustment for late gadolinium enhancement (LGE) and LVEF. ECV ≥ 30% discriminated the arrhythmic risk among LGE+ cases and among those with LVEF ≤ 35%. A simple clinical risk-stratification model, based on LGE, LVEF ≤ 35% and ECV ≥ 30%, achieved an excellent predictive ability (Harrell's C 0.82) and reclassified the risk of 32% of the study population as compared to LVEF ≤ 35% alone.
Comprehensive CMR evaluation in NICM showed that ECV was the only parameter with an independent and strong predictive value for VA/SD, on top of LGE and LVEF. A risk-stratification model based on LGE, LVEF ≤ 35% and ECV ≥ 30% achieved an excellent predictive ability for VA/SD.
UHSM CMR study (NCT02326324) https://clinicaltrials.gov/ct2/show/NCT02326324.
评估基于心脏磁共振成像（CMR）的参数映射和应变分析能否改善非缺血性心肌病（NICM）患者室性心律失常（VA）和猝死（SD）的风险分层。
对一项前瞻性单中心注册研究（NCT02326324）进行二次分析，纳入703例连续的NICM患者，其中618例有细胞外容积（ECV）数据。联合主要终点包括适当的植入式心律转复除颤器治疗、持续性室性心动过速、心脏骤停复苏和SD。在中位随访21个月期间，14例（2%）患者发生主要终点事件。固有T1与主要终点无关。在调整左心室射血分数（LVEF）后，左心室整体纵向应变失去了显著相关性。在有ECV数据的患者中，11例（2%）达到主要终点。平均ECV与主要终点显著相关，最佳截断值为30%。在调整延迟钆增强（LGE）和LVEF后，ECV≥30%是主要终点最强的独立预测因素（风险比14.1，P = 0.01）。ECV≥30%可区分LGE阳性病例和LVEF≤35%患者的心律失常风险。基于LGE、LVEF≤35%和ECV≥30%的简单临床风险分层模型具有出色的预测能力（Harrell氏C指数为0.82），与仅基于LVEF≤35%相比，重新分类了32%研究人群的风险。
NICM的综合CMR评估显示，除LGE和LVEF外，ECV是唯一对VA/SD具有独立且强大预测价值的参数。基于LGE、LVEF≤35%和ECV≥30%的风险分层模型对VA/SD具有出色的预测能力。
UHSM CMR研究（NCT02326324）https://clinicaltrials.gov/ct2/show/NCT02326324
