Fang Qimin, Kan Ao, Li Shuhao, Yu Yaohan, Dai Jiankun, Song Yipei, Wang Xiwen, Xiao Xuan, Xu Lin, Gong Lianggeng
Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiang Xi, China.
Radiology, The Children's Hospital of Zhejiang University School of Medicine, Hang Zhou, Zhe Jiang, China.
Int J Cardiol. 2025 Mar 15;423:133020. doi: 10.1016/j.ijcard.2025.133020. Epub 2025 Jan 29.
Early prediction of left ventricular reverse remodeling (LVRR) can guide the subsequent treatment in dilated cardiomyopathy (DCM) patients. We aimed to investigate the value of left atrium (LA) strain for predicting LVRR in DCM patients.
Clinical and imaging data of DCM patients were gather between January 2018 and January 2023. The participators were divided into LVRR group and non-LVRR group according to the ultrasound follow-up results. CMR images were process to yield LA fast long-axis strain parameters. Univariate and multivariate logistic regression analysis was used to screen the predictors and establish the prediction model.
The study included 116 participants. LVRR occurred in 69 participants within 1 year. Compared with the non-LVRR group, the LVRR group has smaller left ventricular end-diastolic volume index (LVEDVi), late gadolinium enhancement extent (LGE%) and higher left atrial passive eject fraction (LAPEF), left atrial reservoir strain (LARS) and left atrial conduit strain (LACS). In multivariable logistic regression analysis, LVEDVi (HR: 0.990; 95 % CI: 0.981, 0.999; P = 0.037), LACS (HR: 1.434; 95 % CI: 1.025, 2.007; P = 0.035) and LGE% (HR: 0.713; 95 % CI: 0.584, 0.870; P = 0.001) were independent predictors of LVRR. The model based on NYHA, LVEDVi, LGE% and LACS had a better performance in predicting LVRR (AUC = 0.807; 95 % CI: 0.723; 0.874).
LVEDVi, LACS and LGE% were independent predictors of LVRR within 1 year in DCM patients. The combination of NYHA, LVEDVi, LACS and LGE% has a better predictive performance.
左心室逆向重构（LVRR）的早期预测可指导扩张型心肌病（DCM）患者的后续治疗。我们旨在研究左心房（LA）应变对预测DCM患者LVRR的价值。
收集2018年1月至2023年1月期间DCM患者的临床和影像学资料。根据超声随访结果将参与者分为LVRR组和非LVRR组。对心脏磁共振成像（CMR）图像进行处理以得出LA快速长轴应变参数。采用单因素和多因素逻辑回归分析筛选预测因素并建立预测模型。
该研究纳入了116名参与者。69名参与者在1年内发生了LVRR。与非LVRR组相比，LVRR组的左心室舒张末期容积指数（LVEDVi）、延迟钆增强程度（LGE%）较小，而左心房被动射血分数（LAPEF）、左心房储存应变（LARS）和左心房管道应变（LACS）较高。在多因素逻辑回归分析中，LVEDVi（HR：0.990；95%CI：0.981，0.999；P = 0.037）、LACS（HR：1.434；95%CI：1.025，2.007；P = 0.035）和LGE%（HR：0.713；95%CI：0.584，0.870；P = 0.001）是LVRR的独立预测因素。基于纽约心脏协会（NYHA）分级、LVEDVi、LGE%和LACS的模型在预测LVRR方面具有更好的性能（AUC = 0.807；95%CI：0.723；0.874）。
LVEDVi、LACS和LGE%是DCM患者1年内LVRR的独立预测因素。NYHA分级、LVEDVi、LACS和LGE%的组合具有更好的预测性能。
