From the Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), The First School of Clinical Medicine of Zhejiang Chinese Medical University, No. 54 Youdian Rd, Hangzhou 310006, China (Y. Gao, Y. Guo, J.S., P.X., M.X.); Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China (C.P., X.H., Y.W., H.H.); Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (C.P.); Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Q.L., Q.Z., R.Y.); and Medical Imaging Research Institute of Longgang, The Third People's Hospital of Longgang District, Shenzhen, China (Z.Z.).
Radiology. 2024 Mar;310(3):e232388. doi: 10.1148/radiol.232388.
Background Right atrial (RA) function strain is increasingly acknowledged as an important predictor of adverse events in patients with diverse cardiovascular conditions. However, the prognostic value of RA strain in patients with dilated cardiomyopathy (DCM) remains uncertain. Purpose To evaluate the prognostic value of RA strain derived from cardiac MRI (CMR) feature tracking (FT) in patients with DCM. Materials and Methods This multicenter, retrospective study included consecutive adult patients with DCM who underwent CMR between June 2010 and May 2022. RA strain parameters were obtained using CMR FT. The primary end points were sudden or cardiac death or heart transplant. Cox regression analysis was used to determine the association of variables with outcomes. Incremental prognostic value was evaluated using C indexes and likelihood ratio tests. Results A total of 526 patients with DCM (mean age, 51 years ± 15 [SD]; 381 male) were included. During a median follow-up of 41 months, 79 patients with DCM reached the primary end points. At univariable analysis, RA conduit strain was associated with the primary end points (hazard ratio [HR], 0.82 [95% CI: 0.76, 0.87]; < .001). In multivariable Cox analysis, RA conduit strain was an independent predictor for the primary end points (HR, 0.83 [95% CI: 0.77, 0.90]; < .001). A model combining RA conduit strain with other clinical and conventional imaging risk factors (C statistic, 0.80; likelihood ratio, 92.54) showed improved discrimination and calibration for the primary end points compared with models with clinical variables (C statistic, 0.71; likelihood ratio, 37.12; both < .001) or clinical and imaging variables (C statistic, 0.75; likelihood ratio, 64.69; both < .001). Conclusion CMR FT-derived RA conduit strain was an independent predictor of adverse outcomes among patients with DCM, providing incremental prognostic value when combined in a model with clinical and conventional CMR risk factors. Published under a CC BY 4.0 license.
背景 右心房（RA）功能应变越来越被认为是多种心血管疾病患者不良事件的重要预测指标。然而，RA 应变在扩张型心肌病（DCM）患者中的预后价值仍不确定。目的 评估心脏磁共振（CMR）特征追踪（FT）衍生的 RA 应变在 DCM 患者中的预后价值。材料和方法 这是一项多中心、回顾性研究，纳入了 2010 年 6 月至 2022 年 5 月间接受 CMR 的连续成年 DCM 患者。使用 CMR FT 获得 RA 应变参数。主要终点为猝死或心脏性死亡或心脏移植。Cox 回归分析用于确定与结局相关的变量。使用 C 指数和似然比检验评估增量预后价值。结果 共纳入 526 例 DCM 患者（平均年龄 51 岁±15[SD]；381 例男性）。中位随访 41 个月期间，79 例 DCM 患者达到主要终点。单变量分析显示，RA 腔室应变与主要终点相关（危险比 [HR]，0.82[95%CI：0.76，0.87]；<0.001）。多变量 Cox 分析显示，RA 腔室应变是主要终点的独立预测因素（HR，0.83[95%CI：0.77，0.90]；<0.001）。结合 RA 腔室应变与其他临床和常规影像学危险因素的模型（C 统计量，0.80；似然比，92.54）显示，与仅包含临床变量的模型（C 统计量，0.71；似然比，37.12；均<0.001）或包含临床和影像学变量的模型（C 统计量，0.75；似然比，64.69；均<0.001）相比，对主要终点的区分度和校准度均有所提高。结论 CMR FT 衍生的 RA 腔室应变是 DCM 患者不良结局的独立预测因素，与临床和常规 CMR 危险因素联合建模时可提供额外的预后价值。在知识共享署名 4.0 许可下发布。
