Varghese Bibin, Zghaib Tarek, Xie Eric, Zimmerman Stefan L, Gilotra Nisha A, Okada David R, Lima Joao A C, Chrispin Jonathan
Division of Cardiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States.
Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
Am Heart J Plus. 2022 Sep 20;22:100209. doi: 10.1016/j.ahjo.2022.100209. eCollection 2022 Oct.
Right ventricular (RV) dysfunction and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) are associated with ventricular arrhythmias (VA) and mortality in cardiac sarcoidosis (CS). However, image resolution limits the detection of RV LGE. Global longitudinal RV strain (RVS) correlates to RV scar on electroanatomical mapping and RV function.
We evaluated the association between RVS on CMR and VA/death (combined-primary-endpoint (CPE)) in patients with CS.
RVS and RV LGE on MRI were retrospectively compared to variables known to predict outcomes in 66 patients with CS. Outcomes were obtained from electronic medical records and implantable cardioverter defibrillator (ICD) interrogations over median [IQR] 3.7[1.7, 6.3] years. Cox proportional hazard models were used to evaluate survival. Harrell's C-statistic was used to compare variables in risk prediction models.
62.1 % of patients were male, with a mean age [SD] of 52.3 [9.6] years and left ventricular ejection fraction (LVEF) of 51.1[17.5]%. 9 patients with the primary endpoint were more likely to be Caucasian (p = 0.01) with prior VAs (p = 0.002), be on anti-arrhythmic drugs (p = 0.001) with an ICD (p = 0.002). In multivariable analyses adjusted for age, race, and history of VA, RVS (1.18 [1.05-1.31], p = 0.004), RV EDVI (1.08[1.01, 1.14], p = 0.02), and LV LGE (1.07[1.00, 1.13], p = 0.04) predicted the CPE. Risk prediction models including RVS (Cstatistic 0.94), outperformed those including RV and LV LGE (0.89-0.92).
RVS on CMR was the best predictor of VA and mortality in CS.
心脏磁共振成像（CMR）显示的右心室（RV）功能障碍和晚期钆增强（LGE）与心脏结节病（CS）中的室性心律失常（VA）及死亡率相关。然而，图像分辨率限制了右心室LGE的检测。整体纵向右心室应变（RVS）与电解剖标测中的右心室瘢痕及右心室功能相关。
我们评估了CS患者CMR上的RVS与VA/死亡（联合主要终点（CPE））之间的关联。
回顾性比较了66例CS患者MRI上的RVS和右心室LGE与已知可预测预后的变量。通过电子病历和植入式心律转复除颤器（ICD）问询获取中位时间为3.7[1.7, 6.3]年的预后数据。采用Cox比例风险模型评估生存率。使用Harrell's C统计量比较风险预测模型中的变量。
62.1%的患者为男性，平均年龄[标准差]为52.3[9.6]岁，左心室射血分数（LVEF）为51.1[17.5]%。9例达到主要终点的患者更可能是白种人（p = 0.01），有既往VA史（p = 0.002），正在服用抗心律失常药物（p = 0.001）且植入了ICD（p = 0.002）。在对年龄、种族和VA病史进行校正的多变量分析中，RVS（1.18[1.05 - 1.31]，p = 0.004）、右心室舒张末期容积指数（RV EDVI，1.08[1.01, 1.14]，p = 0.02）和左心室LGE（1.07[1.00, 1.13]，p = 0.04）可预测CPE。包含RVS的风险预测模型（C统计量0.94）优于包含右心室和左心室LGE的模型（0.89 - 0.92）。
CMR上的RVS是CS中VA和死亡率的最佳预测指标。
