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新诊断无症状性心脏结节病患者长期预后不良的预测因素:一项心血管磁共振研究

Predictors of Poor Long-Term Outcomes in Patients with Newly Diagnosed Asymptomatic Cardiac Sarcoidosis: A Cardiovascular Magnetic Resonance Study.

作者信息

Nita Nicoleta, Felbel Dominik, Melnic Rima, Paukovitsch Michael, Rottbauer Wolfgang, Buckert Dominik, Mörike Johannes

机构信息

Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany.

出版信息

Biomedicines. 2025 Apr 30;13(5):1093. doi: 10.3390/biomedicines13051093.

Abstract

The prevalence of patients with cardiac sarcoidosis (CS) diagnosed at a subclinical stage has increased; however, their long-term outcomes are not well known. : To investigate the incidence and predictors of adverse long-term outcomes in newly diagnosed patients with asymptomatic CS. : Forty-three patients with newly diagnosed asymptomatic CS and comprehensive baseline evaluation with cardiovascular magnetic resonance (CMR) were studied. Asymptomatic CS was defined as CS in patients with biopsy-proven extracardiac sarcoidosis without cardiac symptoms but with abnormalities on CMR or positron emission tomography according to Heart Rhythm Society criteria. The primary endpoint was a composite of all-cause mortality, new ventricular arrhythmia or an atrioventricular block requiring cardiac device implantation, and hospitalization for heart failure. : Patients had a mean age of 56 ± 11 years and presented with normal left ventricular (LV) ejection fraction (58 ± 4%). A total of 44.2% of patients reached the composite endpoint during 5 years of follow-up. Patients with the primary endpoint were predominantly female (73.7%) and had a significantly higher prevalence of right ventricular (RV) involvement compared to patients without the primary endpoint (RV late gadolinium enhancement (LGE) in 26.3% vs. 4.2%, = 0.037). In multivariate regression analysis, extensive LV LGE (HR 1.61, 95% CI 1.16-2.04, = 0.004) and impaired RV global longitudinal strain (GLS) at baseline (HR 0.46, 95% CI 0.24-0.68, = 0.015) were significantly predictive of the primary endpoint, whereas treatment with corticosteroids after CS diagnosis was significantly associated with improved outcomes (HR 7.69, 95% CI 1.11-11.11, = 0.044). : Newly diagnosed patients with asymptomatic CS have a significant incidence of adverse outcomes after 5 years of follow-up. The extent of LV LGE and impaired RV GLS at baseline predict poor long-term outcomes in asymptomatic CS.

摘要

亚临床阶段诊断出的心脏结节病(CS)患者的患病率有所增加;然而,他们的长期预后尚不清楚。:研究新诊断的无症状CS患者不良长期预后的发生率和预测因素。:对43例新诊断的无症状CS患者进行了研究,并通过心血管磁共振(CMR)进行了全面的基线评估。无症状CS被定义为根据心律学会标准,经活检证实有心脏外结节病且无心脏症状,但CMR或正电子发射断层扫描有异常的患者。主要终点是全因死亡率、新出现的室性心律失常或需要植入心脏装置的房室传导阻滞以及因心力衰竭住院的综合指标。:患者的平均年龄为56±11岁,左心室(LV)射血分数正常(58±4%)。在5年的随访期间,共有44.2%的患者达到综合终点。达到主要终点的患者以女性为主(73.7%),与未达到主要终点的患者相比,右心室(RV)受累的患病率显著更高(RV晚期钆增强(LGE)分别为26.3%和4.2%,P = 0.037)。在多变量回归分析中,广泛的LV LGE(HR 1.61,95%CI 1.16 - 2.04,P = 0.004)和基线时受损的RV整体纵向应变(GLS)(HR 0.46,95%CI 0.24 - 0.68,P = 0.015)是主要终点的显著预测因素,而CS诊断后使用皮质类固醇治疗与改善预后显著相关(HR 7.69,95%CI 1.11 - 11.11,P = 0.044)。:新诊断的无症状CS患者在随访5年后不良结局的发生率较高。基线时LV LGE的范围和受损的RV GLS可预测无症状CS患者的长期预后不良。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb0d/12109307/075d959f8917/biomedicines-13-01093-g001.jpg

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