Department of Radiology, State Key Laboratory of Biotherapy, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, 20# South Renmin Road, Chengdu, 610041, Sichuan, China.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
BMC Cardiovasc Disord. 2022 Dec 6;22(1):526. doi: 10.1186/s12872-022-02963-5.
Cardiac magnetic resonance (CMR) has been used to diagnose and risk-stratify patients with left ventricular noncompaction (LVNC). The prognostic value of CMR parameters for LVNC, especially feature tracking (CMR-FT), is not well known in LVNC patients with left ventricular dysfunction. The present study aimed to investigate whether the combination of CMR-FT with traditional CMR parameters can increase the prognostic value of CMR for LVNC patients with reduced left ventricular ejection fraction (LVEF).
A total of 123 candidates were retrospectively included in this multicenter study and 55 LVNC patients (mean age, 45.7 ± 16.2 years; 61.8% men) remained after applying the exclusion criteria. Clinical features, left ventricular (LV) function parameters, global and segment myocardial strain, and late gadolinium enhancement (LGE) were evaluated. The outcomes include the composite events of cardiovascular death, heart transplantation, hospitalization for heart failure, thromboembolic events, and ventricular arrhythmias.
After a median follow-up of 5.17 years (interquartile range: 0.17 to 10.58 years), 24 (36.8%) patients experienced at least one major adverse cardiovascular event (MACE). The myocardial strain parameters of patients with events were lower than those of patients without events. In the univariable Cox analysis, LVEF, the presence of LGE, global longitudinal strain (GLS) and segmental strains, including longitudinal strain at the apical level and radial and circumferential strain at the basal level, were significantly associated with MACEs. In the multivariate analysis, LGE (hazard ratio (HR) 3.452, 95% CI 1.133 to 10.518, p = 0.029) was a strong predictor of MACEs and significantly improved the predictive value (chi-square of the model after adding LGE: 7.51 vs. 13.47, p = 0.009). However, myocardial strain parameters were not statistically significant for the prediction of MACEs after adjusting for age, body mass index, LVEF and the presence of LGE and did not increase the prognostic value (chi-square of the model after adding GLS: 13.47 vs. 14.14, p = 0.411) in the multivariate model.
The combination of CMR-FT with traditional CMR parameters may not increase the prognostic value of CMR in LVNC patients with reduced LVEF, while the presence of LGE was a strong independent predictor of MACEs and significantly improved the predictive value.
心脏磁共振（CMR）已用于诊断和对左室心肌致密化不全（LVNC）患者进行风险分层。CMR 参数，尤其是特征追踪（CMR-FT），对左室射血分数（LVEF）降低的 LVNC 患者的预后价值尚不清楚。本研究旨在探讨 CMR-FT 与传统 CMR 参数相结合是否能增加 CMR 对 LVEF 降低的 LVNC 患者的预后价值。
本多中心研究回顾性纳入了 123 名候选人，应用排除标准后，55 名 LVNC 患者（平均年龄 45.7±16.2 岁；61.8%为男性）符合入组条件。评估临床特征、左心室（LV）功能参数、整体和节段心肌应变以及晚期钆增强（LGE）。结局包括心血管死亡、心脏移植、心力衰竭住院、血栓栓塞事件和室性心律失常的复合事件。
中位随访 5.17 年（四分位距：0.17 至 10.58 年）后，24 名（36.8%）患者至少发生了 1 次主要不良心血管事件（MACE）。发生事件的患者心肌应变参数低于未发生事件的患者。单变量 Cox 分析显示，LVEF、LGE、整体纵向应变（GLS）和节段应变，包括心尖水平的纵向应变以及基底水平的径向和周向应变，与 MACE 显著相关。多变量分析显示，LGE（危险比（HR）3.452，95%置信区间 1.133 至 10.518，p=0.029）是 MACE 的强预测因子，并显著改善了预测价值（加入 LGE 后模型的卡方值：7.51 比 13.47，p=0.009）。然而，在调整年龄、体重指数、LVEF 和 LGE 存在后，心肌应变参数对 MACE 的预测不具有统计学意义，且在多变量模型中并未增加预后价值（加入 GLS 后模型的卡方值：13.47 比 14.14，p=0.411）。
CMR-FT 与传统 CMR 参数相结合可能不会增加 LVEF 降低的 LVNC 患者的 CMR 预后价值，而 LGE 的存在是 MACE 的强独立预测因子，并显著提高了预测价值。
