Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
School of Computer Science, Northwestern Polytechnical University, Xi'an, China.
J Cardiovasc Magn Reson. 2024 Summer;26(1):101005. doi: 10.1016/j.jocmr.2024.101005. Epub 2024 Feb 1.
The prognostic value of left ventricular (LV) myocardial trabecular complexity on cardiovascular magnetic resonance (CMR) in dilated cardiomyopathy (DCM) remains unknown. This study aimed to evaluate the prognostic value of LV myocardial trabecular complexity using fractal analysis in patients with DCM.
Consecutive patients with DCM who underwent CMR between March 2017 and November 2021 at two hospitals were prospectively enrolled. The primary endpoints were defined as the combination of all-cause death and heart failure hospitalization. The events of cardiac death alone were defined as the secondary endpoints.LV trabeculae complexity was quantified by measuring the fractal dimension (FD) of the endocardial border based on fractal geometry on CMR. Cox proportional hazards regression and Kaplan-Meier survival analysis were used to examine the association between variables and outcomes. The incremental prognostic value of FD was assessed in nested models.
A total of 403 patients with DCM (49.31 ± 14.68 years, 69% male) were recruited. After a median follow-up of 43 months (interquartile range, 28-55 months), 87 and 24 patients reached the primary and secondary endpoints, respectively. Age, heart rate, New York Heart Association functional class >II, N-terminal pro-B-type natriuretic peptide, LV ejection fraction, LV end-diastolic volume index, LV end-systolic volume index, LV mass index, presence of late gadolinium enhancement, global FD, LV mean apical FD, and LV maximal apical FD were univariably associated with the outcomes (all P < 0.05). After multivariate adjustment, LV maximal apical FD remained a significant independent predictor of outcome [hazard ratio = 1.179 (1.116, 1.246), P < 0.001]. The addition of LV maximal apical FD in the nested models added incremental prognostic value to other common clinical and imaging risk factors (all <0.001; C-statistic: 0.84-0.88, P < 0.001).
LV maximal apical FD was an independent predictor of the adverse clinical outcomes in patients with DCM and provided incremental prognostic value over conventional clinical and imaging risk factors.
左心室（LV）心肌小梁复杂性在心血管磁共振（CMR）中的预后价值在扩张型心肌病（DCM）中尚不清楚。本研究旨在使用分形分析评估 DCM 患者 LV 心肌小梁复杂性的预后价值。
前瞻性纳入 2017 年 3 月至 2021 年 11 月在两家医院接受 CMR 的连续 DCM 患者。主要终点定义为全因死亡和心力衰竭住院的组合。仅心脏死亡的事件定义为次要终点。LV 小梁复杂性通过基于 CMR 上分形几何的心内膜边界的分形维数（FD）来量化。Cox 比例风险回归和 Kaplan-Meier 生存分析用于检查变量与结局之间的关联。嵌套模型中评估 FD 的增量预后价值。
共纳入 403 例 DCM 患者（49.31±14.68 岁，69%为男性）。中位随访 43 个月（四分位距，28-55 个月）后，87 例和 24 例患者分别达到主要和次要终点。年龄、心率、纽约心脏协会功能分类>II 级、N 末端 pro-B 型利钠肽、LV 射血分数、LV 舒张末期容积指数、LV 收缩末期容积指数、LV 质量指数、晚期钆增强存在、整体 FD、LV 平均心尖 FD 和 LV 最大心尖 FD 与结局均无关（均 P<0.05）。多变量调整后，LV 最大心尖 FD 仍然是结局的显著独立预测因子[风险比=1.179（1.116，1.246），P<0.001]。在嵌套模型中加入 LV 最大心尖 FD 增加了其他常见临床和影像学危险因素的增量预后价值（均<0.001；C 统计量：0.84-0.88，P<0.001）。
LV 最大心尖 FD 是 DCM 患者不良临床结局的独立预测因子，并提供了比传统临床和影像学危险因素更具增量预后价值的信息。
