From the Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, University Health Network (UHN), 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.D.I., J.F.M., P.T., R.M.W., M.M., R.H., K.H.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.D.I., J.F.M., P.T., R.M.W., M.M., K.H.); Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada (W.H.L., N.d.S., Y.M., P.T., R.M.W.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada (Y.M., P.T., R.M.W., K.H.).
Radiol Cardiothorac Imaging. 2024 Dec;6(6):e240147. doi: 10.1148/ryct.240147.
Purpose To evaluate pectoralis muscle thickness at routine cardiac MRI as a marker of sarcopenia, including prognostic significance for major adverse cardiac events (MACE), interobserver agreement, and correlation with physiologic parameters. Materials and Methods This retrospective cohort study included adult patients undergoing cardiac MRI for assessment of suspected cardiomyopathy between October 2018 and February 2020. Measurements of maximum pectoralis major thickness were performed by two experienced radiologists using axial images at the level of the carina. A random subset of 50 patients were re-evaluated to assess intra- and interobserver agreement. The primary end point was MACE, defined as a composite of cardiac death, resuscitated sudden cardiac death, appropriate implantable cardioverter defibrillator discharge, or hospitalization for heart failure. Prognostic significance of pectoralis major thickness measurements for MACE was assessed using Cox proportional hazard models, and correlation between muscle thickness measurements and cardiopulmonary exercise testing (CPET), performed within 1 year of MRI, was assessed using Spearman correlation. Results The study included 1045 patients (mean age, 50 years ± 17 [SD]; 642 male, 403 female). After median follow-up of 3.3 years (IQR: 2.3-3.9 years), MACE occurred in 66 patients. In multivariable models adjusted for patient age, left ventricular ejection fraction, late gadolinium enhancement, and cardiomyopathy cause, pectoralis major muscle thickness was predictive of MACE in both male (hazard ratio [HR], 0.89 [95% CI: 0.85, 0.94]; < .001) and female patients (HR, 0.85 [95% CI: 0.76, 0.96]; = .008), with improved model fit in nested models. Pectoralis muscle thickness measurements had excellent intra- and interobserver agreement (intraclass correlation coefficient, 0.99 and 0.95, respectively) and correlated with absolute peak oxygen uptake ( = 0.65, < .0001) and oxygen uptake efficiency slope ( = 0.61, < .001) in the subset who underwent CPET within 1 year of MRI ( = 258). Conclusion Pectoralis major muscle thickness at routine cardiac MRI is a simple, reproducible measure of sarcopenia that was associated with MACE occurrence in male and female patients and correlated with CPET parameters. Cardiac, Cardiomyopathies, MR Imaging © RSNA, 2024.
目的 评估常规心脏 MRI 中的胸大肌厚度作为肌肉减少症的标志物，包括对主要不良心脏事件 (MACE) 的预测意义、观察者间的一致性以及与生理参数的相关性。
材料与方法 本回顾性队列研究纳入了 2018 年 10 月至 2020 年 2 月期间因疑似心肌病而行心脏 MRI 评估的成年患者。由两名有经验的放射科医生使用轴向图像在隆突水平测量最大胸大肌厚度。对随机抽取的 50 例患者进行重新评估，以评估观察者内和观察者间的一致性。主要终点为 MACE，定义为心脏性死亡、复苏性心源性猝死、适当的植入式心脏复律除颤器放电或心力衰竭住院的复合终点。使用 Cox 比例风险模型评估胸大肌厚度测量值对 MACE 的预测意义，并使用 Spearman 相关分析评估 MRI 后 1 年内进行的心肺运动试验 (CPET) 与肌肉厚度测量值之间的相关性。
结果 该研究纳入了 1045 例患者（平均年龄，50 岁±17[标准差]；642 例男性，403 例女性）。中位随访 3.3 年后（IQR：2.3-3.9 年），66 例患者发生 MACE。在调整患者年龄、左心室射血分数、晚期钆增强和心肌病病因的多变量模型中，胸大肌肌肉厚度在男性（风险比 [HR]，0.89 [95%CI：0.85，0.94]； <.001）和女性患者（HR，0.85 [95%CI：0.76，0.96]； =.008）中均可预测 MACE，嵌套模型的拟合度得到改善。胸大肌厚度测量具有极好的观察者内和观察者间一致性（组内相关系数分别为 0.99 和 0.95），并与 CPET 后 1 年内进行的绝对峰值摄氧量（ = 0.65， <.0001）和摄氧量效率斜率（ = 0.61， <.001）相关（ = 258）。
结论 在常规心脏 MRI 中，胸大肌厚度是一种简单、可重复的肌肉减少症测量方法，与男性和女性患者的 MACE 发生相关，并与 CPET 参数相关。
心脏 心肌病 磁共振成像 © 2024 RSNA
