Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Bayer Healthcare, Shanghai, China.
ESC Heart Fail. 2023 Dec;10(6):3340-3351. doi: 10.1002/ehf2.14529. Epub 2023 Sep 12.
Left ventricular reverse remodelling (LVRR) is an important objective of optimal medical management for dilated cardiomyopathy (DCM) patients, as it is associated with favourable long-term outcomes. Cardiac magnetic resonance (CMR) can comprehensively assess cardiac structure and function. We aimed to assess the CMR parameters at baseline and investigate independent variables to predict LVRR in DCM patients.
Nighty-eight initially diagnosed DCM patients who underwent CMR and echocardiography examinations at baseline were included. CMR parameters and feature tracking (FT) based left ventricular (LV) global strain (nStrain) and nStrain indexed to LV cardiac mass index (rStrain) were measured. The predictors of LVRR were determined by multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of CMR parameters and were compared by the DeLong test. At a median follow-up time of 9 [interquartile range, 7-12] months, 35 DCM patients (36%) achieved LVRR. The patients with LVRR had lower LV volume, mass, LGE extent and stroke volume index (LVSVi) and higher left ventricular remodelling index (LVRI), nStrains, rStrains, and peak systolic strain rate (PSSR) in the longitudinal direction and rStrains in the circumferential direction at baseline (all P < 0.05). In the multivariate logistic regression analyses, LVRI [per SD, odds ratio (OR) 1.79; 95% confidence interval (CI) 1.08-2.98; P = 0.024] and the ratio of global longitudinal peak strain (rGLPS) (per SD, OR 1.88; 95% CI 1.18-3.01; P = 0.008) were independent predictors of LVRR. The combination of LVSVi, LVRI, and rGLPS had a greater area under the curve (AUC) than the combination of LVSVi and LVRI (0.75 vs. 0.68), but not significantly (P = 0.09).
Patients with LVRR had a lower LV volume index, lower LVSV index, lower LGE extent, higher LVRI, and preserved myocardial deformation in the longitudinal direction at baseline. LVRI and rGLPS at baseline were independent determinants of LVRR.
左心室逆向重构（LVRR）是扩张型心肌病（DCM）患者最佳药物治疗的重要目标，因为它与有利的长期预后相关。心脏磁共振（CMR）可以全面评估心脏结构和功能。我们旨在评估 DCM 患者基线时的 CMR 参数，并研究独立变量以预测 LVRR。
本研究共纳入了 98 名最初诊断为 DCM 的患者，这些患者在基线时接受了 CMR 和超声心动图检查。测量了 CMR 参数和基于特征追踪（FT）的左心室（LV）整体应变（nStrain）和 nStrain 与 LV 心肌质量指数（rStrain）的比值（rStrain）。通过多元逻辑回归分析确定 LVRR 的预测因子。使用接收者操作特征（ROC）曲线评估 CMR 参数的诊断性能，并通过 DeLong 检验进行比较。在中位数为 9 个月[四分位距，7-12]的随访中，35 名 DCM 患者（36%）实现了 LVRR。与未实现 LVRR 的患者相比，实现 LVRR 的患者基线时的 LV 容积、质量、LGE 范围和每搏输出量指数（LVSVi）较低，左心室重构指数（LVRI）、nStrain、rStrain、纵向峰值收缩应变率（PSSR）和圆周方向 rStrain 较高（均 P<0.05）。在多元逻辑回归分析中，LVRI[每标准差，比值比（OR）1.79；95%置信区间（CI）1.08-2.98；P=0.024]和整体纵向峰值应变比（rGLPS）（每标准差，OR 1.88；95%CI 1.18-3.01；P=0.008）是 LVRR 的独立预测因子。LVSVi、LVRI 和 rGLPS 的组合的曲线下面积（AUC）大于 LVSVi 和 LVRI 的组合（0.75 比 0.68），但无统计学差异（P=0.09）。
实现 LVRR 的患者基线时的 LV 容积指数较低，LVSV 指数较低，LGE 范围较低，LVRI 较高，纵向心肌变形保持完好。LVRI 和 rGLPS 是 LVRR 的独立决定因素。
