Hammersley Daniel J, Mukhopadhyay Srinjay, Chen Xiuyu, Jones Richard E, Ragavan Aaraby, Javed Saad, Rajabali Husein, Androulakis Emmanuel, Curran Lara, Mach Lukas, Khalique Zohya, Baruah Resham, Guha Kaushik, Gregson John, Zhao Shihua, De Marvao Antonio, Tayal Upasana, Lota Amrit S, Ware James S, Pennell Dudley J, Prasad Sanjay K, Halliday Brian P
King's College Hospital NHS Foundation Trust, London, UK.
National Heart and Lung Institute, Imperial College London, London, UK.
Eur J Heart Fail. 2024 Dec;26(12):2553-2562. doi: 10.1002/ejhf.3425. Epub 2024 Aug 15.
To assess whether left ventricular (LV) global longitudinal strain (GLS), derived from cardiovascular magnetic resonance (CMR), is associated with (i) progressive heart failure (HF), and (ii) sudden cardiac death (SCD) in patients with dilated cardiomyopathy with mildly reduced ejection fraction (DCMmrEF).
We conducted a prospective observational cohort study of patients with DCM and LV ejection fraction (LVEF) ≥40% assessed by CMR, including feature-tracking to assess LV GLS and late gadolinium enhancement (LGE). Long-term adjudicated follow-up included (i) HF hospitalization, LV assist device implantation or HF death, and (ii) SCD or aborted SCD (aSCD). Of 355 patients with DCMmrEF (median age 54 years [interquartile range 43-64], 216 men [60.8%], median LVEF 49% [46-54]) followed up for a median 7.8 years (5.2-9.4), 32 patients (9%) experienced HF events and 19 (5%) died suddenly or experienced aSCD. LV GLS was associated with HF events in a multivariable model when considered as either a continuous (per % hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.00-1.21, p = 0.045) or dichotomized variable (LV GLS > -15.4%: HR 2.70, 95% CI 1.30-5.94, p = 0.008). LGE presence was not associated with HF events (HR 1.49, 95% CI 0.73-3.01, p = 0.270). Conversely, LV GLS was not associated with SCD/aSCD (per % HR 1.07, 95% CI 0.95-1.22, p = 0.257), whereas LGE presence was (HR 3.58, 95% CI 1.39-9.23, p = 0.008). LVEF was neither associated with HF events nor SCD/aSCD.
Multi-parametric CMR has utility for precision prognostic stratification of patients with DCMmrEF. LV GLS stratifies risk of progressive HF, while LGE stratifies SCD risk.
评估通过心血管磁共振成像（CMR）得出的左心室（LV）整体纵向应变（GLS）是否与以下因素相关：（i）射血分数轻度降低的扩张型心肌病（DCMmrEF）患者的进行性心力衰竭（HF）；（ii）心源性猝死（SCD）。
我们对通过CMR评估的DCM且左心室射血分数（LVEF）≥40%的患者进行了一项前瞻性观察队列研究，包括特征追踪以评估LV GLS和延迟钆增强（LGE）。长期的判定性随访包括：（i）HF住院、左心室辅助装置植入或HF死亡；（ii）SCD或SCD未遂（aSCD）。在355例DCMmrEF患者（年龄中位数54岁[四分位间距43 - 64岁]，男性216例[60.8%]，LVEF中位数49%[46 - 54]）中，进行了中位数7.8年（5.2 - 9.4年）的随访，32例患者（9%）发生了HF事件，19例（5%）突然死亡或经历了aSCD。在多变量模型中，LV GLS被视为连续变量（每降低1%风险比[HR] 1.10，95%置信区间[CI] 1.00 - 1.21，p = 0.045）或二分变量（LV GLS > -15.4%：HR 2.70，95% CI 1.30 - 5.94，p = 0.008）时，与HF事件相关。LGE的存在与HF事件无关（HR 1.49，95% CI 0.73 - 3.01，p = 0.270）。相反，LV GLS与SCD/aSCD无关（每降低1% HR 1.07，95% CI 0.95 - 1.22，p = 0.257），而LGE的存在与之相关（HR 3.58，95% CI 1.39 - 9.23）。LVEF与HF事件和SCD/aSCD均无关。
多参数CMR对DCMmrEF患者的精准预后分层具有实用价值。LV GLS可对进行性HF风险进行分层，而LGE可对SCD风险进行分层。
