Graduate School of Bengbu Medical College, Bengbu, Anhui, China.
Division of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
ESC Heart Fail. 2023 Dec;10(6):3538-3545. doi: 10.1002/ehf2.14534. Epub 2023 Sep 22.
The purpose of this study was to explore the predictive value of wall thickness measured by cardiac magnetic resonance (CMR) for all-cause mortality in dilated cardiomyopathy (DCM) patients.
DCM patients who underwent CMR and completed the regular follow-up were included in this study. The left ventricular end-diastolic diameter (LVDd), left ventricular end-diastolic volume (LVEDV), left ventricular posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular ejection fraction, and left ventricular mass (LVM) were measured by CMR. The presence and extent of late gadolinium enhancement (LGE) were also assessed. The relative posterior wall thickness (RWT ) and relative interventricular septum wall thickness (RWT ) were defined by the following equations: RWT = (2 × PWT)/LVDd, and RWT = (2 × IVST)/LVDd. All patients received regular telephone and outpatient follow-up. The primary endpoint was all-cause mortality. A total of 161 patients were enrolled in this study, including 126 (78.3%) males. The mean age was 52.3 ± 13.6 years. During the median follow-up of 47 months (interquartile range 32-57 months), 41 (24.8%) patients died. Compared with the non-death group, LVDd (75.2 ± 11.9 vs. 70.5 ± 8.8 mm; P = 0.025) was greater in the death group, while PWT [5.2 mm (3.7-6.8) vs. 6.9 mm (5.3-8.6); P < 0.001], IVST [8.2 mm (6.5-9.5) vs. 9.3 mm (7.4-10.5); P = 0.005], RWT [0.15 (0.11-0.19) vs. 0.20 (0.15-0.25); P < 0.001], RWT [0.22 (0.17-0.26) vs. 0.26 (0.22-0.31); P < 0.001], and LVM/LVEDV ratio (0.5 ± 0.2 vs. 0.7 ± 0.2 g/mL; P < 0.001) were lower. The presence of LGE [LGE(+)] was more frequent in the death group (75.6% vs. 58.3%; P = 0.048). However, the LGE extent was not significantly different between the two groups [4 (1-7) vs. 2 (0-6); P = 0.096]. Multivariate Cox regression analysis showed that PWT [hazard ratio (HR) 0.086, 95% confidence interval (CI) 0.665-0.976; P < 0.05] and RWT (HR 0.001, 95% CI 0.000-0.502; P < 0.05) were independent predictors of all-cause death. In contrast, IVST, RWT , and the presence of LGE were not clearly associated with death.
PWT measured by CMR is an independent predictor of all-cause mortality in DCM patients. However, there was no significant correlation between septum wall thickness and mortality.
本研究旨在探讨心脏磁共振（CMR）测量的壁厚度对扩张型心肌病（DCM）患者全因死亡率的预测价值。
本研究纳入了接受 CMR 检查并完成常规随访的 DCM 患者。通过 CMR 测量左心室舒张末期直径（LVDd）、左心室舒张末期容积（LVEDV）、左心室后壁厚度（PWT）、室间隔厚度（IVST）、左心室射血分数和左心室质量（LVM）。还评估了晚期钆增强（LGE）的存在和程度。相对后壁厚度（RWT）和相对室间隔壁厚度（RWT）通过以下公式定义：RWT =（2 × PWT）/LVDd，RWT =（2 × IVST）/LVDd。所有患者均接受定期电话和门诊随访。主要终点为全因死亡率。本研究共纳入 161 例患者，其中 126 例（78.3%）为男性。平均年龄为 52.3 ± 13.6 岁。在中位数为 47 个月（四分位距 32-57 个月）的随访期间，41 例（24.8%）患者死亡。与非死亡组相比，死亡组的 LVDd 更大（75.2 ± 11.9 比 70.5 ± 8.8 mm；P = 0.025），而 PWT [5.2 mm（3.7-6.8）比 6.9 mm（5.3-8.6）；P < 0.001]、IVST [8.2 mm（6.5-9.5）比 9.3 mm（7.4-10.5）；P = 0.005]、RWT [0.15（0.11-0.19）比 0.20（0.15-0.25）；P < 0.001]、RWT [0.22（0.17-0.26）比 0.26（0.22-0.31）；P < 0.001]和 LVM/LVEDV 比值（0.5 ± 0.2 比 0.7 ± 0.2 g/mL；P < 0.001）均较低。死亡组 LGE 阳性（LGE（+））的发生率更高（75.6%比 58.3%；P = 0.048）。然而，两组之间的 LGE 程度无显著差异[4（1-7）比 2（0-6）；P = 0.096]。多变量 Cox 回归分析显示，PWT [风险比（HR）0.086，95%置信区间（CI）0.665-0.976；P < 0.05]和 RWT（HR 0.001，95% CI 0.000-0.502；P < 0.05）是全因死亡的独立预测因子。相比之下，IVST、RWT 和 LGE 的存在与死亡无明显相关性。
CMR 测量的 PWT 是 DCM 患者全因死亡率的独立预测因子。然而，室间隔壁厚度与死亡率之间没有显著相关性。
