心脏 MRI 特征追踪和 T1 映射在致心律失常性右心室心肌病中的递增预后价值。
Incremental Prognostic Value of Cardiac MRI Feature Tracking and T1 Mapping in Arrhythmogenic Right Ventricular Cardiomyopathy.
机构信息
From the Department of Radiology (G.L., L.C., W.Y., X.L., J.O., Y.Y., H.L.) and Guangdong Cardiovascular Institute (Q.Z., Y.L.), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou 510080, China; Department of Interventional Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (G.L.); Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China (X.W.); Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China (J.X.); Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China (Z.D.); Department of Pediatrics, The First Clinical College, Guangdong Medical University, Zhanjiang, China (X.Z.); and School of Medicine, South China University of Technology, Guangzhou, China (X.L., H.L.).
出版信息
Radiol Cardiothorac Imaging. 2024 Oct;6(5):e230430. doi: 10.1148/ryct.230430.
Purpose To explore the role of cardiac MRI feature tracking (FT) and T1 mapping in predicting sustained ventricular arrhythmias (VA) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate their possible incremental value beyond ARVC risk score. Materials and Methods The retrospective study analyzed 91 patients with ARVC (median age, 36 years [IQR, 27-50 years]; 60 male, 31 female) who underwent cardiac MRI examinations between November 2010 and March 2022. The primary end point was the first occurrence of sustained VA after cardiac MRI to first VA, with censoring of patients who were alive without VA at last follow-up. Cox regression analysis was performed to assess the association between variables and time to sustained VA. Time-dependent receiver operating characteristic (ROC) analysis was performed to determine the incremental value of cardiac MRI FT and T1 mapping. Results During a median follow-up of 55.0 months (IQR, 37.0-76.0 months), 36 of 91 (40%) patients experienced sustained VA. A 1% worsening in left ventricular global longitudinal peak strain (GLS), 1% worsening in right ventricular GLS, and a 1% increase in extracellular volume fraction (ECV) were associated with increased risk of sustained VA, with hazard ratios of 1.14 (95% CI: 1.06, 1.23; = .001), 1.09 (95% CI: 1.02, 1.16; = .02), and 1.13 (95% CI: 1.08, 1.18; < .001), respectively, after adjustment for ARVC risk score. Adding both biventricular GLS and ECV to ARVC risk score showed significant incremental value for predicting sustained VA (area under the ROC curve: 0.73 vs 0.65; < .001). Conclusion Cardiac MRI-derived biventricular GLS and ECV provided independent and incremental value for predicting sustained VA beyond ARVC risk score alone in patients with ARVC. Cardiovascular MRI, Feature Tracking, T1 Mapping, Arrhythmogenic Right Ventricular Cardiomyopathy, Sustained Ventricular Arrhythmias Published under a CC BY 4.0 license.
目的
探讨心脏 MRI 特征追踪（FT）和 T1 映射在预测致心律失常性右心室心肌病（ARVC）患者持续性室性心律失常（VA）中的作用，并探讨其在 ARVC 风险评分之外的可能增量价值。
材料和方法
这项回顾性研究分析了 91 名接受心脏 MRI 检查的 ARVC 患者（中位年龄，36 岁[IQR，27-50 岁]；60 名男性，31 名女性），这些患者均在 2010 年 11 月至 2022 年 3 月间接受了检查。主要终点是心脏 MRI 后首次 VA 至首次 VA 后持续性 VA 的首次发生，并在最后一次随访时无 VA 存活的患者中进行了删失。采用 Cox 回归分析评估变量与持续性 VA 时间之间的关联。采用时间依赖性接受者操作特征（ROC）分析来确定心脏 MRI FT 和 T1 映射的增量价值。
结果
在中位随访 55.0 个月（IQR，37.0-76.0 个月）期间，91 名患者中有 36 名（40%）发生持续性 VA。左心室整体纵向峰值应变（GLS）恶化 1%、右心室 GLS 恶化 1%和细胞外容积分数（ECV）增加 1%与持续性 VA 风险增加相关，风险比分别为 1.14（95%CI：1.06，1.23；=.001）、1.09（95%CI：1.02，1.16；=.02）和 1.13（95%CI：1.08，1.18；<.001），校正 ARVC 风险评分后。将双心室 GLS 和 ECV 均添加到 ARVC 风险评分中，对预测持续性 VA 具有显著的增量价值（ROC 曲线下面积：0.73 比 0.65；<.001）。
结论
在 ARVC 患者中，心脏 MRI 衍生的双心室 GLS 和 ECV 提供了独立且增量的价值，可预测 ARVC 风险评分以外的持续性 VA。
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