Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China.
Eur Heart J Cardiovasc Imaging. 2023 Jun 21;24(7):876-884. doi: 10.1093/ehjci/jead065.
To explore the prognosis of myocardial oedema measured by T2 mapping in hypertrophic cardiomyopathy (HCM).
A total of 674 patients with HCM (age: 50 ± 15 years, 60.5% males) who underwent cardiovascular magnetic resonance were prospectively enrolled from 2011 to 2020. One hundred healthy controls (age: 48 ± 19 years, 58.0% males) were included for comparison. Myocardial oedema was quantitatively measured by T2 mapping in both global and segmental myocardium. The endpoints were defined as a combination of cardiovascular death and appropriate implantable cardioverter defibrillator discharge. During a median follow-up of 36 months (interquartile range: 24-60 months), 55 patients (8.2%) had cardiovascular events. Patients with cardiovascular events had a higher T2 max, T2 min, and T2 global values (all P < 0.001) than patients who remained event free. Survival analysis demonstrated that patients with HCM with late gadolinium enhancement [LGE(+)] and T2 max ≥44.9 ms had a higher risk of developing cardiovascular events (P < 0.001). A multivariate Cox regression analysis showed that T2 max, T2 min, and T2 global provided significant prognostic value to predict cardiovascular events (all P < 0.001). According to the C-index (0.825, 0.814), net reclassification index (0.612, 0.536, both P < 0.001), and integrative discrimination index (0.029, 0.029, both P < 0.05), T2 max or T2 min significantly increased the predictive performance of established risk factors, including extensive LGE.
Patients with HCM with LGE(+) and higher T2 had worse prognosis than those with LGE(+) and lower T2.
探讨 T2 映射测量肥厚型心肌病（HCM）心肌水肿的预后。
前瞻性纳入 2011 年至 2020 年期间接受心血管磁共振检查的 674 例 HCM 患者（年龄：50 ± 15 岁，60.5%为男性），并纳入 100 名健康对照者（年龄：48 ± 19 岁，58.0%为男性）进行比较。通过 T2 映射对整体和节段心肌进行定量测量心肌水肿。终点定义为心血管死亡和适当植入式心脏复律除颤器放电的组合。在中位数为 36 个月（四分位距：24-60 个月）的随访期间，55 例患者（8.2%）发生心血管事件。发生心血管事件的患者 T2max、T2min 和 T2 全局值均高于无事件患者（均 P < 0.001）。生存分析表明，具有晚期钆增强 [LGE(+)] 和 T2max≥44.9ms 的 HCM 患者发生心血管事件的风险更高（P < 0.001）。多变量 Cox 回归分析表明，T2max、T2min 和 T2 全局值对预测心血管事件具有显著的预后价值（均 P < 0.001）。根据 C 指数（0.825、0.814）、净重新分类指数（0.612、0.536，均 P < 0.001）和综合判别指数（0.029、0.029，均 P < 0.05），T2max 或 T2min 显著提高了包括广泛 LGE 在内的既定危险因素的预测性能。
与 LGE(+)和较低 T2 的 HCM 患者相比，具有 LGE(+)和较高 T2 的 HCM 患者预后更差。
