Tang Zehui, Wei Chuangwei, Zhao Wenjing, Liu Dongting, Liu Jiayi, Qin Huai, Pan Lili, Zhang Nan, Wen Zhaoying
Department of Medical Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2024 Sep 19;11:1475535. doi: 10.3389/fcvm.2024.1475535. eCollection 2024.
To investigate the prevalence and characteristics of late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) and its prognostic value in patients with Takayasu arteritis (TA).
Sixty TA patients with a CMR examination were retrospectively included. All TA patients were divided into with LGE-positive and LGE-negative groups. Bi-ventricular function and location, distribution, and pattern of left ventricular (LV) LGE were evaluated in both LGE-positive and LGE-negative groups. Primary outcome was defined as a composite of cardiovascular death, hospitalization for heart failure, coronary artery revascularization, and stroke. Univariate and multivariate Cox proportional hazard regression analyses were used to evaluate the association between variables and primary outcomes.
Sixty consecutive TA patients were enrolled in this study. The mean age was 38.2 ± 13.8 years and 54 patients (54/60, 90.0%) were female. LGE-positive was observed in twenty-one (21/60, 35%) patients in the total patients with TA. LGE was predominantly distributed in the middle wall and subendocardial. The patchy and infarcted LGE patterns were the most common. Compared with the LGE-negative group, the LGE-positive group had reduced LV ejection fraction ( = 0.033), elevated LV end-diastolic volume index ( = 0.008), LV end-systolic volume index ( = 0.012), and LV mass ( = 0.008). During a median follow-up period of 1,892 days (interquartile range: 1,764-1,988 days), the primary outcomes occurred in thirteen patients. In the univariate analysis, LGE-positive (hazard ratio [HR] = 4.478, 95% confidence interval [CI]: 1.376-14.570; = 0.013) were independently associated with the primary outcomes. However, LGE-positive did not retain its value as an independent predictor of primary outcomes in the multivariate analysis. Instead, LVMI (HR = 1.030, 95%CI: 1.013-1.048; = 0.001) was the strongest independent predictor of primary outcomes in patients with TA. The Kaplan-Meier plot revealed that patients with LVMI ≥ 57.5 g/m have a worse prognosis.
LGE-positive detected by CMR was observed in 35% of total TA patients with different distributions and patterns. LGE is associated with adverse LV remodeling and worsen cardiac function. However, LVMI rather than LGE can provide independent prognostic information in patients with TA.
通过心脏磁共振成像（CMR）研究高安动脉炎（TA）患者延迟钆增强（LGE）的发生率、特征及其预后价值。
回顾性纳入60例接受CMR检查的TA患者。所有TA患者分为LGE阳性组和LGE阴性组。对LGE阳性组和LGE阴性组的双心室功能以及左心室（LV）LGE的位置、分布和模式进行评估。主要结局定义为心血管死亡、因心力衰竭住院、冠状动脉血运重建和中风的综合情况。采用单因素和多因素Cox比例风险回归分析评估变量与主要结局之间的关联。
本研究连续纳入60例TA患者。平均年龄为38.2±13.8岁，54例患者（54/60，90.0%）为女性。在TA患者中，21例（21/60，35%）观察到LGE阳性。LGE主要分布在心肌中层和心内膜下。斑片状和梗死样LGE模式最为常见。与LGE阴性组相比，LGE阳性组左心室射血分数降低（=0.033），左心室舒张末期容积指数升高（=0.008）、左心室收缩末期容积指数升高（=0.012）以及左心室质量增加（=0.008）。在中位随访期1892天（四分位间距：1764 -1988天）内，13例患者出现主要结局。在单因素分析中，LGE阳性（风险比[HR]=4.478，95%置信区间[CI]：1.376 - 14.570；=0.013）与主要结局独立相关。然而，在多因素分析中，LGE阳性不再是主要结局的独立预测指标。相反，左心室质量指数（LVMI）（HR=1.030，95%CI：1.013 - 1.048；=0.001）是TA患者主要结局最强的独立预测指标。Kaplan-Meier曲线显示，LVMI≥57.5 g/m²的患者预后较差。
在35%的TA患者中观察到CMR检测的LGE阳性，其具有不同的分布和模式。LGE与不良的左心室重构和心脏功能恶化相关。然而，在TA患者中，LVMI而非LGE能提供独立的预后信息。
