心肌瘢痕面积预测缺血性心肌病患者冠状动脉旁路移植术后主要不良心血管事件  

Myocardial scar area predicts major adverse cardiovascular events after coronary artery bypass grafting in patients with ischemic cardiomyopathy

作　　者：付威 赵洋[1] 张魁[1] 戴沁怡[2] 张宏凯 朱马泰 郑居兵[1] 董然[1] Fu Wei;Zhao Yang;Zhang Kui;Dai Qinyi;Zhang Hongkai;Jumatay Biekan;Zheng Jubing;Dong Ran(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Circle Cardiovascular Imaging,Calgary T2P3T6,Canada)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029 [2]首都医科大学附属北京安贞医院放射科,北京100029 [3]加拿大圆心影像有限公司,卡尔加里T2P3T6

出　　处：《中华心血管病杂志》2024年第8期906-913,共8页Chinese Journal of Cardiology

基　　金：国家自然科学基金(82270408)。

摘　　要：目的探讨心肌瘢痕面积预测缺血性心肌病患者冠状动脉旁路移植(CABG)术后发生不良心血管事件(MACEs)的价值。方法本研究第1部分为回顾性研究, 入选2017年1月至2022年12月在首都医科大学附属北京安贞医院诊断为缺血性心肌病并接受CABG手术治疗的患者作为发现队列, 入选患者术前均行心脏磁共振-延迟钆强化检查, 根据术后是否发生MACEs分为MACEs组和无MACEs组。收集并比较两组患者术前临床及影像资料、术中及术后相关资料。主要终点为术后发生MACEs。采用单因素和多因素回归分析影响缺血性心肌病患者CABG术后发生MACEs的相关危险因素, 构建受试者工作特征(ROC)曲线, 评估心肌瘢痕面积对终点事件的预测效能和最佳临界值。本研究第2部分为前瞻性研究, 入选2023年1至6月在首都医科大学附属北京安贞医院接受CABG的缺血性心肌病患者作为验证队列, 根据术后是否发生MACEs分为MACEs组和无MACEs组, 收集并比较两组患者术前临床及影像资料、术中及术后相关资料。在验证队列中验证ROC曲线获得界值的可靠性。结果发现队列共纳入120例缺血性心肌病患者(MACEs组30例, 无MACEs组90例), 年龄(61.6±8.7)岁, 男性93例。验证队列共纳入22例缺血性心肌病患者(MACEs组5例, 无MACEs组17例), 年龄(59.5±8.2)岁, 男性18例。多因素Cox回归示心肌瘢痕面积(HR=1.258, 95%CI:1.096~1.444, P=0.001)是主要终点事件的独立危险因素。心肌瘢痕面积预测术后发生MACEs的ROC曲线下面积为0.90(95%CI:0.83~0.95), 心肌瘢痕面积≥36.0%是预测术后发生MACEs的最佳临界值, 其敏感度、特异度和准确度分别为96.7%、72.2%和78.3%。在验证队列中, 心肌瘢痕面积预测缺血性心肌病患者CABG术后发生MACEs的敏感度、特异度和准确度分别为 80.0%, 82.4%和81.8%。结论心肌瘢痕面积是缺血性心肌病患者CABG术后是否发生MACEs的独立危险因素, 心�Objective:To investigate the value of myocardium scar area in predicting adverse cardiovascular events(MACEs)after coronary artery bypass grafting(CABG)in patients with ischemic cardiomyopathy(ICM).Methods:The first part of this study was a retrospective study.Patients diagnosed with ICM and undergoing CABG surgery at Beijing Anzhen Hospital,Capital Medical University from January 2017 to December 2022 were enrolled as the discovery cohort.All patients underwent cardiac magnetic resonance-late gadolinium enhancement(CMR-LGE)before surgery.According to the occurrence of postoperative MACEs,the patients were divided into MACEs group and MACEs-free group.Preoperative clinical and imaging data,intraoperative and postoperative data were collected and compared between the two groups.The primary endpoint was postoperative MACEs.Univariate and multifactor regression analyses were used to analyze the risk factors for MACEs.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy and optimal cut-off value of myocardial scar area for endpoint events.The second part of this study was a prospective study.Patients with ICM who received CABG at Beijing Anzhen Hospital,Capital Medical University from January 2023 to June 2023 were enrolled as a validation cohort,and were divided into MACEs group and MACEs-free group according to whether MACEs occurred after surgery.Preoperative clinical and imaging data,intraoperative and postoperative data were collected and compared between the two groups.Verify the reliability of the cut-off value obtained by ROC curve in the validation cohort.Results:A total of 120 patients with ICM(30 patients in MACEs group and 90 patients in MACEs-free group),aged(61.6±8.7)years,including 93 males,were included in the discovery cohort.A total of 22 ICM patients(5 patients in MACEs group and 17 patients in MACEs-free group),aged(59.5±8.2)years,including 18 males,were included in the validation cohort.Multivariate Cox regression showed that myocardial scar area(HR=

关 键 词：冠状动脉旁路移植术 缺血性心肌病 心脏磁共振 钆对比剂延迟强化 主要不良心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病]