左心室重构指数预测射血分数＜35%的扩张型心肌病患者发生室性快速心律失常的情况。

Left ventricular remodeling index to predict ventricular tachyarrhythmia in dilated cardiomyopathy with ejection fraction < 35.

作者信息

Jia Xi, Yan Weipeng, Ma Xuan, Dong Zhixiang, Wang Jiaxin, Yang Shujuan, Zhao Kankan, Wei Zhuxin, Tang Yun, Zhou Pengyu, Chen Xingrui, Liu Yujie, Chen Xiuyu, Zhao Shihua

机构信息

Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.

出版信息

Insights Imaging. 2025 Aug 29;16(1):188. doi: 10.1186/s13244-025-02059-6.

DOI:10.1186/s13244-025-02059-6

PMID:40883611

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12397014/

Abstract

OBJECTIVES

To assess the left ventricular remodeling index (LVRI) for predicting ventricular tachyarrhythmia (VTA) in patients with dilated cardiomyopathy (DCM) with left ventricular ejection fraction (LVEF) < 35%.

MATERIALS AND METHODS

In this retrospective single-center study, consecutive DCM patients with LVEF < 35% (n = 271) who underwent cardiac magnetic resonance (CMR) imaging were followed up. The study endpoint was VTA, including sudden cardiac death and major ventricular arrhythmias. The CMR-derived LVRI was defined as the cubic root of the LV end-diastolic volume divided by the maximal LV wall thickness. Competing risk regression analysis and Kaplan-Meier analysis were used to evaluate the association of LVRI with VTA.

RESULTS

Over 71-month median follow-up (interquartile range: 17-134 months), 35 (12.9%, mean age 46.7 years, 27 males) participants reached VTA events. The presence (62.9% vs. 60.2%, p = 0.761) and extent (6.9 ± 6.6 vs. 6.5 ± 8.3, p = 0.747) of late gadolinium enhancement (LGE) and LVEF (23.3 ± 6 vs. 21.9 ± 10.3, p = 0.197) were not significantly different between the patients with and without endpoint. Kaplan-Meier curve analysis showed that participants with LVRI ≥ 7.5 were more likely to experience VTA (p < 0.0001). In the multiple competing risk analysis, LVRI ≥ 7.5 (HR, 2.496; 95% CI: 1.213-5.138; p = 0.013) was observed as an independent predictor of VTA after adjusting for age, sex and left bundle branch block.

CONCLUSIONS

For nonischemic DCM patients with LVEF < 35%, LVRI ≥ 7.5 was associated with lethal VTA events and provided incremental value over conventional CMR parameters.

CRITICAL RELEVANCE STATEMENT

The left ventricular remodeling index (LVRI) was independently associated with ventricular tachyarrhythmias in dilated cardiomyopathy patients with LVEF < 35%, and warrants future multicenter validation to assess incremental value over established predictors for implantable cardioverter-defibrillator decision-making.

KEY POINTS

Left ventricular ejection fraction did not exhibit significant prognostic value for end-stage dilated cardiomyopathy patients. Cardiac MRI (CMR)-assessed left ventricular remodeling index (LVRI) ≥ 7.5 was an independent predictor of ventricular tachyarrhythmia. LVRI provided incremental prognostic value over conventional CMR parameters.

摘要

目的

评估左心室重构指数（LVRI）对预测左心室射血分数（LVEF）<35%的扩张型心肌病（DCM）患者室性快速心律失常（VTA）的价值。

材料与方法

在这项回顾性单中心研究中，对连续接受心脏磁共振（CMR）成像检查的LVEF<35%的DCM患者（n = 271）进行随访。研究终点为VTA，包括心源性猝死和主要室性心律失常。CMR衍生的LVRI定义为左心室舒张末期容积的立方根除以左心室最大壁厚。采用竞争风险回归分析和Kaplan-Meier分析评估LVRI与VTA的关联。

结果

在中位71个月的随访期（四分位间距：17 - 134个月）内，35例（12.9%，平均年龄46.7岁，27例男性）参与者发生VTA事件。有终点事件和无终点事件的患者之间，晚期钆增强（LGE）的存在情况（62.9%对60.2%，p = 0.761）和范围（6.9±6.6对6.5±8.3，p = 0.747）以及LVEF（23.3±6对21.9±10.3，p = 0.197）无显著差异。Kaplan-Meier曲线分析显示，LVRI≥7.5的参与者发生VTA的可能性更高（p<0.0001）。在多因素竞争风险分析中，调整年龄、性别和左束支传导阻滞因素后，LVRI≥7.5（风险比，2.496；95%可信区间：1.213 - 5.138；p = 0.013）是VTA的独立预测因子。