微血管功能障碍与肥厚型心肌病的预后相关：来自体素内不相干运动 MRI 的观察。
Microvascular Dysfunction Associates With Outcomes in Hypertrophic Cardiomyopathy: Insights From the Intravoxel Incoherent Motion MRI.
机构信息
Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Clinical Medical College, Lanzhou University, Lanzhou, China.
出版信息
J Magn Reson Imaging. 2023 Jun;57(6):1766-1775. doi: 10.1002/jmri.28450. Epub 2022 Oct 6.
BACKGROUND
Although intravoxel incoherent motion (IVIM) MRI has emerged as an in vivo marker of tissue diffusion and perfusion, its prognostic value in patients with hypertrophic cardiomyopathy (HCM) remains unclear.
PURPOSE
To investigate whether IVIM-MRI derived parameters are associated with outcomes in patients with HCM.
STUDY TYPE
Prospective cohort.
SUBJECTS
A total of 112 patients (51.72 ± 17.13 years) with suspected or known HCM.
FIELD STRENGTH/SEQUENCE: Single-shot echo planar IVIM imaging, balanced steady-state free precession, and phase-sensitive inversion-recovery late gadolinium enhancement (LGE) sequences at 3 T.
ASSESSMENT
All patients were followed up of 29.3 ± 12.3 months for combined major adverse cardiac events (MACE) including cardiac death, aborted sudden death, heart transplantation, and rehospitalization for heart failure. The CVI42 imaging platform was used to assess morphological and functional MRI indices and to quantify LGE. The Body Diffusion Toolbox was used to derive pseudo diffusion (D*), water molecular diffusion (D) and perfusion fraction (f).
STATISTICAL TESTS
Univariable and stepwise multivariable Cox model analyses were used to investigate the association between variables and composite endpoints. Kaplan-Meier curves were constructed to assess event-free survival, and the event rates were compared by the log-rank test.
RESULTS
A total of 19 patients reached endpoints. Patients with MACE showed a significantly impaired D* value, lower f value, and more extensive LGE than those without MACE (all, P < 0.05), while there was no significant difference in D value (P = 0.285). In the Cox regression models, D* value (hazard ratio [HR] 0.93; 95% CI: 0.88-0.98) and f value (HR 0.65; 95% CI: 0.45-0.92) were independent predictors for MACE. Moreover, in Kaplan-Meier survival analysis, the incidence of MACE was significantly higher in patients with decreased D* value and f value.
CONCLUSIONS
Impaired D* and f values derived from IVIM-MRI are associated with adverse outcomes in patients with HCM.
LEVEL OF EVIDENCE
2 TECHNICAL EFFICACY STAGE: 2.
背景
尽管体素内不相干运动（IVIM）MRI 已成为组织扩散和灌注的活体标志物，但它在肥厚型心肌病（HCM）患者中的预后价值尚不清楚。
目的
探讨 IVIM-MRI 衍生参数与 HCM 患者结局的相关性。
研究类型
前瞻性队列研究。
受试者
共 112 例（51.72±17.13 岁）疑似或确诊 HCM 的患者。
磁场强度/序列：3T 上的单次激发 echo-planar IVIM 成像、平衡稳态自由进动和相位敏感反转恢复晚期钆增强（LGE）序列。
评估
所有患者均随访 29.3±12.3 个月，主要不良心脏事件（MACE）包括心脏性死亡、心源性猝死、心脏移植和心力衰竭再住院。使用 CVI42 成像平台评估形态学和功能 MRI 指标，并量化 LGE。使用 Body Diffusion Toolbox 来推导假性扩散（D*）、水分子扩散（D）和灌注分数（f）。
统计学检验
使用单变量和逐步多变量 Cox 模型分析来研究变量与复合终点之间的相关性。构建 Kaplan-Meier 曲线评估无事件生存，并通过对数秩检验比较事件发生率。
结果
共有 19 例患者达到终点。与无 MACE 的患者相比，MACE 患者的 D值显著降低、f 值更低，且 LGE 范围更广（均 P<0.05），而 D 值无显著差异（P=0.285）。在 Cox 回归模型中，D值（风险比 [HR]0.93；95%置信区间：0.88-0.98）和 f 值（HR 0.65；95%置信区间：0.45-0.92）是 MACE 的独立预测因子。此外，在 Kaplan-Meier 生存分析中，D*值和 f 值降低的患者发生 MACE 的风险显著更高。
结论
IVIM-MRI 衍生的 D*和 f 值降低与 HCM 患者的不良结局相关。
证据水平
2 技术功效等级：2。
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