Chayanopparat Punyanuch, Boonyasirinant Thananya, Prapan Natthaporn, Phoopattana Supamongkol, Kaolawanich Yodying
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Front Cardiovasc Med. 2023 Oct 18;10:1281563. doi: 10.3389/fcvm.2023.1281563. eCollection 2023.
Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging has emerged as an important tool for assessment of patients with dilated cardiomyopathy (DCM). Electrocardiography (ECG) is an accessible, reproducible, low-cost diagnostic and prognostic tool. This study aimed to investigate the ECG characteristics associated with LGE, as well as to assess the prognostic significance of ECG in patients with DCM.
Consecutive patients diagnosed with DCM by CMR [left ventricular ejection fraction (LVEF) < 50%] between 2011 and 2020 were included. Multivariable analysis was conducted to evaluate ECG predictors associated with LGE. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of ECG in combination of clinical data and LVEF for LGE. Two composite outcomes were also assessed among patients with and without ECG predictors: (1) sudden cardiac death (SCD), sustained ventricular arrhythmia, or appropriate implantable cardioverter-defibrillator (ICD) therapy, and (2) all-cause death or hospitalization for heart failure.
A total of 422 patients, with a mean age of 59.5 ± 16.3 years (58.3% male), were included. LGE was present in 169 (40%) of the patients. Multivariable analysis identified lateral inverted T-waves, intraventricular conduction delay, low voltage, and fragmented QRS as independent predictors of LGE. ROC analysis showed a significant increase in the area under the curve (AUC) when ECG predictors of the four aforementioned characteristics were added to the clinical-LVEF model (AUC 0.66, 95% CI 0.59-0.71 vs. 0.72, 95% CI 0.67-0.78, = 0.003). During a median follow-up of 2.7 years (IQR 0.8, 5.2), 16 events of SCD, sustained ventricular arrhythmia, or appropriate ICD therapy, and 70 events of all-cause death or hospitalization for heart failure occurred. ECG predictors were independently associated with SCD, sustained ventricular arrhythmia, or appropriate ICD therapy (HR 4.84, 95% CI 1.34-17.40, = 0.01). However, ECG predictors were not associated with all-cause death or hospitalization for heart failure (HR 1.22, 95% CI 0.76-1.96, = 0.39).
In patients with DCM, lateral inverted T-waves, intraventricular conduction delay, low voltage, and fragmented QRS were independently associated with LGE. Additionally, these ECG predictors had prognostic value for predicting SCD, sustained ventricular arrhythmia, or appropriate ICD therapy, assisting clinicians in stratifying SCD risk and identifying primary prevention ICD implantation candidates.
延迟钆增强（LGE）心脏磁共振成像（CMR）已成为评估扩张型心肌病（DCM）患者的重要工具。心电图（ECG）是一种易于获取、可重复、低成本的诊断和预后评估工具。本研究旨在探讨与LGE相关的ECG特征，并评估ECG在DCM患者中的预后意义。
纳入2011年至2020年间通过CMR诊断为DCM（左心室射血分数[LVEF]<50%）的连续患者。进行多变量分析以评估与LGE相关的ECG预测因素。进行受试者操作特征（ROC）分析，以评估结合临床数据和LVEF的ECG对LGE的诊断性能。在有和没有ECG预测因素的患者中还评估了两个复合结局：（1）心源性猝死（SCD）、持续性室性心律失常或适当的植入式心律转复除颤器（ICD）治疗，以及（2）全因死亡或因心力衰竭住院。
共纳入422例患者，平均年龄59.5±16.3岁（58.3%为男性）。169例（40%）患者存在LGE。多变量分析确定侧壁T波倒置、室内传导延迟、低电压和碎裂QRS波为LGE的独立预测因素。ROC分析显示，当将上述四个特征的ECG预测因素添加到临床-LVEF模型中时，曲线下面积（AUC）显著增加（AUC 0.66，95%CI 0.59-0.71对0.72，95%CI 0.67-0.78，P=0.003）。在中位随访2.7年（四分位间距0.8，5.2）期间，发生了16例SCD、持续性室性心律失常或适当的ICD治疗事件，以及70例全因死亡或因心力衰竭住院事件。ECG预测因素与SCD、持续性室性心律失常或适当的ICD治疗独立相关（HR 4.84，95%CI 1.34-17.40，P=0.01）。然而，ECG预测因素与全因死亡或因心力衰竭住院无关（HR 1.22，95%CI 0.76-1.96，P=0.39）。
在DCM患者中，侧壁T波倒置、室内传导延迟、低电压和碎裂QRS波与LGE独立相关。此外，这些ECG预测因素对预测SCD、持续性室性心律失常或适当的ICD治疗具有预后价值，有助于临床医生对SCD风险进行分层并识别一级预防ICD植入候选者。
