Xing Xing, Li Xiaofei, Fan Xiaohan, Liu Xiaoqiang, Zhang Yi, Zhang Lei, Yao Yan, Wang Fang
Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
NMR Biomed. 2025 Sep;38(9):e70098. doi: 10.1002/nbm.70098.
Risk stratification for sudden cardiac death (SCD) mainly relies on severely reduced left ventricular ejection fraction (LVEF), but its poor predictive efficacy fails to meet clinical needs. Myocardial scarring identified using cardiac magnetic resonance (CMR) imaging has emerged as a potent risk indicator for SCD and life-threatening ventricular tachyarrhythmias (LTVTA). This study aimed to develop a risk prediction score for SCD and ventricular tachyarrhythmias in symptomatic heart failure. Consecutive patients with nonischemic heart failure undergoing CMR were monitored from 2018 to 2024. A risk stratification score was developed by integrating CMR parameters with clinical variables. Among the 199 patients, the median LVEF was 32.7%, and the average age was 50.3 ± 15.2 years. During a median observation period of 3 years, 21 (10.5%) patients experienced LTVTA. Among multiple CMR parameters, the presence of late gadolinium enhancement (LGE) was the only independent risk factor for LTVTA. The final risk scoring model comprised the presence of LGE (hazard ratio, 10.68; p = 0.023), assigned a score of 2; syncope (hazard ratio, 4.41; p = 0.003), assigned a score of 1; and nonsustained ventricular tachycardia (hazard ratio, 3.82; p = 0.004), assigned a score of 1. A total score of ≥ 3 was considered high risk. Harrell's C-statistic was 0.814 in the derivation cohort and 0.785 in the external validation cohort. The 3-year cumulative risks for the low- and high-risk groups were 3.6% and 32.8%, respectively. Among CMR parameters, the presence of LGE was identified as the sole independent and strong risk marker of LTVTA. The novel scoring model may assist in the preliminary screening of patients with symptomatic heart failure with a potentially elevated risk.
心脏性猝死（SCD）的风险分层主要依赖于严重降低的左心室射血分数（LVEF），但其预测效果不佳，无法满足临床需求。利用心脏磁共振（CMR）成像识别的心肌瘢痕已成为SCD和危及生命的室性快速心律失常（LTVTA）的有力风险指标。本研究旨在为有症状心力衰竭患者的SCD和室性快速心律失常制定风险预测评分。对2018年至2024年接受CMR检查的连续性非缺血性心力衰竭患者进行监测。通过将CMR参数与临床变量相结合，制定了一个风险分层评分。在199例患者中，LVEF中位数为32.7%，平均年龄为50.3±15.2岁。在中位观察期3年期间，21例（10.5%）患者发生LTVTA。在多个CMR参数中，钆延迟强化（LGE）的存在是LTVTA的唯一独立危险因素。最终的风险评分模型包括LGE的存在（风险比，10.68；p = 0.023），评分为2分；晕厥（风险比，4.41；p = 0.003），评分为1分；非持续性室性心动过速（风险比，3.82；p = 0.004），评分为1分。总分≥3分被认为是高风险。在推导队列中，Harrell's C统计量为0.814，在外部验证队列中为0.785。低风险组和高风险组的3年累积风险分别为3.6%和32.8%。在CMR参数中，LGE的存在被确定为LTVTA唯一独立且强大的风险标志物。该新型评分模型可能有助于对有症状心力衰竭且潜在风险升高的患者进行初步筛查。
