Feher Attila, Miller Edward J, Peters Dana C, Mojibian Hamid R, Sinusas Albert J, Hinchcliff Monique, Baldassarre Lauren A
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
Rheumatol Int. 2023 May;43(5):849-858. doi: 10.1007/s00296-023-05294-6. Epub 2023 Mar 10.
Impaired left-ventricular (LV) and right-ventricular (RV) cardiac magnetic resonance (CMR) strain has been documented in systemic sclerosis (SSc). However, it is unknown whether the CMR strain is predictive of adverse outcomes in SSc. Therefore, we set out to investigate the prognostic value of CMR strain in SSc. Patients with SSc who underwent CMR for clinical indications between 11/2010 and 07/2020 were retrospectively studied. LV and RV strain was evaluated by feature tracking. The association between strain, late gadolinium enhancement (LGE), and survival was evaluated with time to event and Cox-regression analyses. During the study period, 42 patients with SSc (age: 57 ± 14 years, 83% female, 57% limited cutaneous SSc, SSc duration: 7 ± 8 years) underwent CMR. During the median follow-up of 3.6 years, 11 patients died (26%). Compared to surviving patients, patients who died had significantly worse LV GLS (- 8.2 ± 6.2% versus - 12.1 ± 2.9%, p = 0.03), but no difference in LV global radial, circumferential, or RV strain values. Patients within the quartile of most impaired LV GLS (≥ - 12.8%, n = 10) had worse survival when compared to patients with preserved LV GLS (< - 12.8%, n = 32, log-rank p = 0.02), which persisted after controlling for LV cardiac output, LV cardiac index, reduced LV ejection fraction, or presence of LGE. In addition, patients who had both impaired LV GLS and LGE (n = 5) had worse survival than patients with LGE or impaired GLS alone (n = 14) and compared to those without any of these features (n = 17, p = 0.003). In our retrospective cohort of patients with SSc undergoing CMR for clinical indications, LV GLS and LGE were found to be predictive of overall survival.
系统性硬化症（SSc）患者已被证实存在左心室（LV）和右心室（RV）心脏磁共振成像（CMR）应变受损。然而，CMR应变是否能预测SSc的不良预后尚不清楚。因此，我们着手研究CMR应变在SSc中的预后价值。对2010年11月至2020年7月期间因临床指征接受CMR检查的SSc患者进行回顾性研究。通过特征追踪评估左心室和右心室应变。采用事件发生时间分析和Cox回归分析评估应变、延迟钆增强（LGE）与生存率之间的关联。在研究期间，42例SSc患者（年龄：57±14岁，83%为女性，57%为局限性皮肤型SSc，SSc病程：7±8年）接受了CMR检查。在中位随访3.6年期间，11例患者死亡（26%）。与存活患者相比，死亡患者的左心室整体纵向应变（LV GLS）明显更差（-8.2±6.2%对-12.1±2.9%，p = 0.03），但左心室整体径向、圆周应变或右心室应变值无差异。左心室整体纵向应变受损最严重的四分位数范围内的患者（≥ -12.8%，n = 10）与左心室整体纵向应变正常的患者（< -12.8%，n = 32）相比，生存率更差（对数秩检验p = 0.02），在控制左心室心输出量、左心室心脏指数、左心室射血分数降低或存在LGE后，这种情况仍然存在。此外，左心室整体纵向应变受损且存在LGE的患者（n = 5）比单独存在LGE或左心室整体纵向应变受损的患者（n = 14）以及没有这些特征的患者（n = 17）生存率更差（p = 0.003）。在我们因临床指征接受CMR检查的SSc患者回顾性队列中，发现左心室整体纵向应变和LGE可预测总体生存率。
