Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
Diagn Interv Radiol. 2023 Sep 5;29(5):682-690. doi: 10.4274/dir.2023.221859. Epub 2023 Mar 20.
Left ventricular non-compaction (LVNC) is considered rare; however, the use of cardiac magnetic resonance (CMR) has shown that its incidence is not uncommon, and its clinical presentation remains variable, with an uncertain prognosis. Risk stratification of major adverse cardiac events (MACE) in patients with LVNC remains complex. Therefore, this study aims to determine whether tissue heterogeneity from late gadolinium enhancement-derived entropy is associated with MACE in patients with LVNC.
This study was registered in the Clinical Trial Registry (CTR2200062045). Consecutive patients who underwent CMR imaging and were diagnosed with LVNC were followed up for MACE, which was defined by heart failure, arrhythmias, systemic embolism, and cardiac death. The patients were divided into MACE and non-MACE groups. The CMR parameters included left ventricular (LV) entropy, LV ejection fraction (LVEF), LV end-diastolic volume, LV end-systolic volume (LVESV), and LV mass (LVM).
Eighty-six patients (age: 45.48 ± 16.64 years; female: 62.7%; LVEF: 42.58 ± 17.20%) were followed up for a median of 18 months and experienced 30 MACE events (34.9%). The MACE group showed higher LV entropy, LVESV, and LVM and lower LVEF than the non-MACE group. LV entropy [hazard ratio (HR): 1.710, 95% confidence interval (CI): 1.078-2.714, = 0.023] and LVEF (HR: 0.961, 95% CI: 0.936-0.988, = 0.004) were independent predictors of MACE ( <0.050) according to the Cox regression analysis. Receiver operating characteristic curve analysis revealed that the area under the curve of LV entropy was 0.789 (95% CI: 0.687-0.869, < 0.001), LVEF was 0.804 (95% CI: 0.699-0.878, < 0.001), and the combined model of LV entropy and LVEF was 0.845 (95% CI: 0.751-0.914, < 0.050).
LGE-derived LV entropy and LVEF are independent risk indicators of MACE in patients with LVNC. The combination of the two factors was more conducive to improving the prediction of MACE.
左心室心肌致密化不全（LVNC）被认为较为罕见；然而，心脏磁共振（CMR）的应用表明，其发病率并不罕见，其临床表现仍然多种多样，预后不确定。LVNC 患者的主要不良心脏事件（MACE）风险分层仍然复杂。因此，本研究旨在确定迟钆增强衍生熵的组织异质性是否与 LVNC 患者的 MACE 相关。
本研究在临床试验注册处（CTR2200062045）进行登记。连续接受 CMR 成像并诊断为 LVNC 的患者进行 MACE 随访，MACE 定义为心力衰竭、心律失常、全身栓塞和心脏性死亡。患者分为 MACE 组和非 MACE 组。CMR 参数包括左心室（LV）熵、LV 射血分数（LVEF）、LV 舒张末期容积、LV 收缩末期容积（LVESV）和 LV 质量（LVM）。
86 例患者（年龄：45.48 ± 16.64 岁；女性：62.7%；LVEF：42.58 ± 17.20%）接受了中位数为 18 个月的随访，发生了 30 次 MACE 事件（34.9%）。MACE 组的 LV 熵、LVESV 和 LVM 较高，LVEF 较低。根据 Cox 回归分析，LV 熵（HR：1.710，95%CI：1.078-2.714， = 0.023）和 LVEF（HR：0.961，95%CI：0.936-0.988， = 0.004）是 MACE 的独立预测因子（ <0.050）。LV 熵的受试者工作特征曲线分析显示曲线下面积为 0.789（95%CI：0.687-0.869， < 0.001），LVEF 为 0.804（95%CI：0.699-0.878， < 0.001），LV 熵和 LVEF 的联合模型为 0.845（95%CI：0.751-0.914， < 0.050）。
迟钆增强衍生的 LV 熵和 LVEF 是 LVNC 患者 MACE 的独立风险指标。两种因素的结合更有利于提高 MACE 的预测能力。
