心脏磁共振在肥厚型心肌病危险分层中的研究  

The value of cardiac MRI in the risk stratification in patients with hypertrophic cardiomyopathy

作　　者：王家鑫 杨淑娟 马璇 喻诗琴 董志翔 向晓睿 魏竹馨 崔辰 杨凯 陈秀玉 陆敏杰 赵世华 Wang Jiaxin;Yang Shujuan;Ma Xuan;Yu Shiqin;Dong Zhixiang;Xiang Xiaorui;Wei Zhuxin;Cui Chen;Yang Kai;Chen Xiuyu;Lu Minjie;Zhao Shihua(MR Center,Fuwai Hospital,National Center for Cardiovascular Diseases of China,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院磁共振影像科,北京100037

出　　处：《中华心血管病杂志》2023年第6期619-625,共7页Chinese Journal of Cardiology

基　　金：国家自然科学基金重点项目(81930044);国家重点研发计划(2021YFF0501400,2021YFF0501404)。

摘　　要：目的探讨心脏磁共振(CMR)在肥厚型心肌病(HCM)危险分层中的价值。方法本研究为单中心回顾性研究,连续选取2012年3月至2013年5月于阜外医院接受CMR检查并诊断为HCM的患者,收集患者的临床及CMR资料,通过电话随访和病案记录确认患者生存情况。主要终点为心原性猝死(SCD)或SCD等位事件,次要终点为全因死亡及心脏移植复合终点,根据是否发生主要终点事件分组。采用Cox回归探索不良事件的危险因素,采用受试者工作特征(ROC)曲线评估延迟强化百分比(LGE%)对终点事件的预测效能和最佳临界值,采用Kaplan-Meier法和log-rank检验分析组间生存差异。结果共纳入患者442例,年龄(48.5±12.4)岁,女性143例(32.4%)。随访(7.6±2.5)年,共30例(6.8%)患者发生主要终点事件,包括23例SCD和7例SCD等位事件;共36例(8.1%)患者发生次要终点事件,包括33例死亡,3例心脏移植。多因素Cox回归示,晕厥(HR=4.531,95%CI 2.033~10.099,P<0.001)、LGE%(HR=1.075,95%CI 1.032~1.120,P=0.001)和左心室射血分数(LVEF)(HR=0.956,95%CI 0.923~0.991,P=0.013)是主要终点事件的独立危险因素;年龄(HR=1.032,95%CI 1.001~1.064,P=0.046)、心房颤动(HR=2.977,95%CI 1.446~6.131,P=0.003)、LGE%(HR=1.075,95%CI 1.035~1.116,P<0.001)和LVEF(HR=0.968,95%CI 0.937~1.000,P=0.047)是次要终点事件的独立危险因素。ROC曲线示以5.1%和5.8%为LGE%临界值分别对主要终点和次要终点的预测效能最高。以0、5%和15%为LGE%界值进一步分组的Kaplan-Meier曲线示,LGE%=0、0<LGE%<5%、5%≤LGE%<15%、LGE%≥15%4组患者的主要和次要终点生存差异均有统计学意义(P均<0.001),其中主要终点事件发生率依次为1.2%(2/161)、2.2%(2/89)、10.5%(16/152)和25.0%(10/40)。结论LGE是HCM患者SCD事件以及全因死亡和心脏移植事件的独立危险因素,具有重要的危险分层价值。Objective To explore the value of cardiac magnetic resonance imaging(CMR)in the risk stratification of hypertrophic cardiomyopathy(HCM).Methods HCM patients who underwent CMR examination in Fuwai Hospital between March 2012 and May 2013 were retrospectively enrolled.Baseline clinical and CMR data were collected and patient follow-up was performed using telephone contact and medical record.The primary composite endpoint was sudden cardiac death(SCD)or and equivalent event.The secondary composite endpoint was all-cause death and heart transplant.Patients were divided into SCD and non-SCD groups.Cox regression was used to explore risk factors of adverse events.Receiver operating characteristic(ROC)curve analysis was used to assess the performance and the optimal cut-off of late gadolinium enhancement percentage(LGE%)for the prediction of endpoints.Kaplan-Meier and log-rank tests were used to compare survival differences between groups.Results A total of 442 patients were enrolled.Mean age was(48.5±12.4)years and 143(32.4%)were female.At(7.6±2.5)years of follow-up,30(6.8%)patients met the primary endpoint including 23 SCD and 7 SCD equivalent events,and 36(8.1%)patients met the secondary endpoint including 33 all-cause death and 3 heart transplant.In multivariate Cox regression,syncope(HR=4.531,95%CI 2.033-10.099,P<0.001),LGE%(HR=1.075,95%CI 1.032-1.120,P=0.001)and left ventricular ejection fraction(LVEF)(HR=0.956,95%CI 0.923-0.991,P=0.013)were independent risk factors for primary endpoint;Age(HR=1.032,95%CI 1.001-1.064,P=0.046),atrial fibrillation(HR=2.977,95%CI 1.446-6.131,P=0.003),LGE%(HR=1.075,95%CI 1.035-1.116,P<0.001)and LVEF(HR=0.968,95%CI 0.937-1.000,P=0.047)were independent risk factors for secondary endpoint.ROC curve showed the optimal LGE%cut-offs were 5.1%and 5.8%for the prediction of primary and secondary endpoint,respectively.Patients were further divided into LGE%=0,0<LGE%<5%,5%≤LGE%<15%and LGE%≥15%groups.There were significant survival differences between these 4 groups whether for primary endp

关 键 词：磁共振成像 肥厚型心肌病 心原性猝死 延迟强化 危险分层 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]