熵增加可预测高心血管风险和高血压患者的不良心脏事件：一种源自延迟钆增强的新型成像参数
Increased Entropy Predicts Adverse Cardiac Events in Patients with High Cardiovascular Risk and Hypertension: A Novel Imaging Parameter Derived from Late Gadolinium Enhancement.
作者信息
Zhang Yunbo, Wang Lujing, Wang Jin, Zhao Xinxiang
机构信息
Department of Education, Second Affiliated Hospital of Kunming Medical University, 650000 Kunming, Yunnan, China.
Department of Radiology, Second Affiliated Hospital of Kunming Medical University, 650000 Kunming, Yunnan, China.
出版信息
Rev Cardiovasc Med. 2025 May 27;26(5):26499. doi: 10.31083/RCM26499. eCollection 2025 May.
BACKGROUND
Entropy derived from late gadolinium enhancement (LGE) has been shown to correlate with major adverse cardiac events (MACEs) in various cardiac diseases. However, the association between myocardial entropy and MACEs in patients with hypertension (HTN) has not been reported.
METHODS
This study recruited 190 patients with high cardiovascular risk and essential HTN who underwent cardiac magnetic resonance (CMR) examination in our hospital between January 2020 and June 2024. HTN patients were followed up for MACEs, which were defined as hospitalization for the occurrence of heart failure, acute coronary syndromes, stroke, or all-cause death. Patients were divided into MACE and non-MACE groups. Cardiac morphology, function, and tissue characteristics were assessed using CMR, and left ventricular (LV) entropy was acquired from LGE images.
RESULTS
Of the 190 patients with HTN, 54 (28.4%) experienced a MACE over a median follow-up period of 12.0 (8.0-27.0) months. LV entropy was significantly higher in patients with MACEs than those without (5.75 ± 0.89 vs. 5.12 ± 1.26; < 0.001). Furthermore, LV entropy was an independent predictor of MACE, even after adjustment for clinical risk factors (odds ratio: 1.569 (1.039-2.369); = 0.032). Receiver operating characteristic curve (ROC) analysis showed the predictive value of LV entropy, with an area under the curve (AUC) of 0.663. Adding LV entropy to the clinical model resulted in a relatively higher AUC (0.813 vs. 0.806) for the prediction of MACEs; however, this was not significantly different from the clinical model alone ( = 0.570).
CONCLUSIONS
HTN patients with MACEs presented higher LV entropy than patients without MACEs. Furthermore, as an independent predictor of MACEs, LV entropy may help the risk stratification of HTN patients with high cardiovascular risk.
CLINICAL TRIAL REGISTRATION
ChiCTR2100049160, https://www.chictr.org.cn/showproj.html?proj=130381.
背景
钆延迟增强（LGE）衍生的熵已被证明与各种心脏病中的主要不良心脏事件（MACE）相关。然而，高血压（HTN）患者中心肌熵与MACE之间的关联尚未见报道。
方法
本研究纳入了2020年1月至2024年6月期间在我院接受心脏磁共振（CMR）检查的190例心血管风险高的原发性HTN患者。对HTN患者进行MACE随访，MACE定义为因心力衰竭、急性冠状动脉综合征、中风或全因死亡而住院。患者被分为MACE组和非MACE组。使用CMR评估心脏形态、功能和组织特征，并从LGE图像中获取左心室（LV）熵。
结果
在190例HTN患者中，54例（28.4%）在中位随访期12.0（8.0 - 27.0）个月内发生了MACE。发生MACE的患者LV熵显著高于未发生MACE的患者（5.75±0.89 vs. 5.12±1.26；<0.001）。此外，即使在调整临床危险因素后，LV熵仍是MACE的独立预测因子（比值比：1.569（1.039 - 2.369）；=0.032）。受试者工作特征曲线（ROC）分析显示了LV熵的预测价值，曲线下面积（AUC）为0.663。将LV熵添加到临床模型中，用于预测MACE的AUC相对较高（0.813 vs. 0.806）；然而，这与单独的临床模型相比无显著差异（=0.570）。
结论
发生MACE的HTN患者的LV熵高于未发生MACE的患者。此外，作为MACE的独立预测因子，LV熵可能有助于对心血管风险高的HTN患者进行风险分层。
临床试验注册
ChiCTR2100049160，https://www.chictr.org.cn/showproj.html?proj=130381
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