Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
ESC Heart Fail. 2023 Jun;10(3):1735-1744. doi: 10.1002/ehf2.14334. Epub 2023 Feb 26.
Ring-like late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging is a special LGE pattern in patients with chronic inflammatory cardiomyopathy (infl-CMP), which is associated with cardiac dysfunction and ventricular remodelling and attributed to viral infection followed by bacterial and parasitic infections. Data on the combination of CMR imaging and clinical parameters that can add long-term prognostic value in patients with infl-CMP are still rare. We aimed to evaluate the prognostic value of CMR in risk stratification in this kind of patients.
A total of 319 consecutive patients with clinically suspected myocarditis were retrospectively identified. Forty-seven patients with ring-like LGE on CMR who diagnosed as infl-CMP, and 72 patients with other LGE pattern were eligible for standardized follow-up. The left ventricle (LV) and right ventricle function and mass were analyses by CMR. Myocardial strain of the ventricles was evaluated by feature tracking. Major (cardiac death, resuscitated cardiac arrest, ventricular assist device, transplantation, and appropriate implantable cardioverter-defibrillator shock) and minor (rehospitalization due to heart failure and sustained atrial fibrillation) adverse cardiovascular events were assessed during follow-up since the date of nCMR examination. Cox proportional hazards model was used to investigate which of the prognostic factors identified by univariable analysis were significantly associated with cardiac events. In the ring-like LGE group, adverse cardiac events occurred in 14 (31.11%) patients, including 7 deaths (15.56%), 6 (13.33%) heart-failure hospitalizations, and 1 (2.22%) case of sustained atrial fibrillation during the mean follow-up period of 70.15 ± 45.68 months (interquartile range: 32.83-103.71 months). No major or minor adverse cardiac event occurred in the other LGE pattern group, except rehospitalization in one patient due to arrhythmia. Further analyses of ring-like LGE group by univariable and Multivariable Cox proportional hazard regression analysis showed that body mass index (BMI) (hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.40-0.73, P = 0.000), right ventricle cardiac index (RVCI) (HR: 0.31, 95% CI: 0.14-0.71, P = 0.002), LV basal peak circumferential strain (LV-PCS ) (HR: 1.26, 95% CI: 1.11-1.43, P = 0.000) were independently associated with the long-term outcome. Receiver operator characteristic curve indicated that the cut-off of LV-PCS was -7.95%, and it has added prognostic value to BMI and RVCI.
For infl-CMP patients with ring-like LGE on CMR, low BMI and RVCI were associated with a poor prognosis. LV-PCS with a cut-off of -7.95% can add prognostic value for patients with infl-CMP who have ring-like LGE.
心脏磁共振（CMR）上的环形晚期钆增强（LGE）是慢性炎症性心肌病（infl-CMP）患者的一种特殊 LGE 模式，与心功能障碍和心室重构有关，归因于病毒感染后继发细菌和寄生虫感染。关于能够在 infl-CMP 患者中增加长期预后价值的 CMR 成像和临床参数的综合数据仍然很少。我们旨在评估 CMR 在这种患者危险分层中的预后价值。
回顾性确定了 319 例临床疑似心肌炎的连续患者。47 例 CMR 上出现环形 LGE 并诊断为 infl-CMP 的患者和 72 例具有其他 LGE 模式的患者符合标准化随访条件。通过 CMR 分析左心室（LV）和右心室功能和质量。通过特征跟踪评估心室的心肌应变。在 nCMR 检查之日起的随访期间，评估主要（心脏死亡、复苏性心脏骤停、心室辅助装置、移植和适当的植入式心脏复律除颤器电击）和次要（因心力衰竭和持续性心房颤动而再次住院）不良心血管事件。使用 Cox 比例风险模型来研究单变量分析确定的哪些预后因素与心脏事件显著相关。在环形 LGE 组中，14 例（31.11%）患者发生不良心脏事件，包括 7 例死亡（15.56%）、6 例（13.33%）心力衰竭住院和 1 例（2.22%）持续性心房颤动，平均随访时间为 70.15±45.68 个月（中位数：32.83-103.71 个月）。其他 LGE 模式组中，除了 1 例因心律失常再次住院外，没有发生主要或次要不良心脏事件。通过单变量和多变量 Cox 比例风险回归分析对环形 LGE 组进行进一步分析显示，体重指数（BMI）（风险比[HR]：0.54，95%置信区间[CI]：0.40-0.73，P=0.000）、右心室心指数（RVCI）（HR：0.31，95%CI：0.14-0.71，P=0.002）、LV 基底环向峰值应变（LV-PCS）（HR：1.26，95%CI：1.11-1.43，P=0.000）与长期结果独立相关。受试者工作特征曲线表明，LV-PCS 的截断值为-7.95%，它为具有环形 LGE 的 infl-CMP 患者增加了预后价值。
对于 CMR 上具有环形 LGE 的 infl-CMP 患者，低 BMI 和 RVCI 与预后不良相关。截断值为-7.95%的 LV-PCS 可以为具有环形 LGE 的 infl-CMP 患者增加预后价值。
