心脏磁共振钆对比剂延迟强化对扩张型心肌病患者心脏不良事件的预测价值研究

摘要

Objective To analyze the predictive value of late gadolinium enhancement (LGE) of cardiac magnetic resonance imaging (CMRI) on major adverse cardiac events (MACEs) in patients with dilated cardiomyopathy (DCM).Methods From March 2011 to January 2014,a total of 77 first-visit patients with DCM were continuously selected in Liangxiang Hospital of Fangshan District,Beijing,and they were divided into control group (without LGE of CMRI,n =43)and observation group (with LGE of CMRI,n =34) according to the incidence of LGE of CMRI;according to the number of involved myocardial segments,patients of observation group were divided into A1 group (with 1 to 2 myocardial segments involved or without myocardial segments involved,n =5),A2 group (with 3 to 5 myocardial segments involved,n =18) and A3 group (with equal or over 6 myocardial segments involved,n =11);according to the incidence of permeable wall,patients of observation group were divided into B1 group (with permeable wall,n =13) and B2 group (without permeable wall,n =21).All of the patients were followed up by outpatient service or telephone till to October 2015,and the incidence of MACEs was recorded.Results No statistically significant differences of gender,age,incidence of complete left bundle branch block,proportion of patients treated with ACEI/ARB,β-acceptor blockers,aldosterone antagonist,amiodarone or diuretic was found between the two groups (P ＞ 0.05);NYHA grading of observation group was statistically significantly worse than that of control group,LVEF of observation group was statistically significantly lower than that of control group,while proportion of patients treated with digoxin of observation group was statistically significantly higher than that of control group (P ＜ 0.05).Incidence of rehospitalization caused by heart failure,ventricular tachycardia/ventricular fibrillation,death caused by cardiovascular disease and MACEs of observation group were statistically significantly higher than those of control group (P ＜ 0.05).Compared with control group,risk of MACEs of observation group significantly increased 9.96 times [95％ CI (7.17,13.87)].Incidence of rehospitalization caused by heart failure,ventricular tachycardia/ventricular fibrillation,death caused by cardiovascular disease and MACEs of A2 group and A3 group was statistically significantly higher than that of A1 group,respectively,meanwhile incidence of rehospitalization caused by heart failure,ventricular tachycardia/ventricular fibrillation,death caused by cardiovascular disease and MACEs of A3 group was statistically significantly higher than that of A2 group,respectively (P ＜ 0.05).Compared with A 1 group,risk of MACEs of A2 group significantly increased 4.45 times [95％ CI (2.36,8.33)];compared with A2 group,risk of MACEs of A3 group significantly increased 5.24 times [95％ CI (1.43,19.30)].No statistically significant differences of incidence of rehospitalization caused by heart failure,ventricular tachycardia/ventricular fibrillation or death caused by cardiovascular disease was found between B1 group and B2 group (P ＞ 0.05),while incidence of MACEs of B1 group was statistically significantly higher than that of B2 group (P ＜ 0.05).Compared with B2 group,risk of MACEs of B1 group significantly increased 6.05 times [95％ CI (1.31,27.94)].Conclusion LGE of CMRI and its involving range and degree can predict the risk of MACEs to some extent in patients with DCM.%目的 分析心脏磁共振钆对比剂延迟强化(LGE)对扩张型心肌病(DCM)患者心脏不良事件的预测价值.方法 连续选取2011年3月-2014年1月在北京市房山区良乡医院就诊的初诊DCM患者77例,根据心脏磁共振LGE情况分为无LGE者43例(对照组)和有LGE者34例(观察组);根据LGE累及心肌节段数将有LGE患者分为0～2个心肌节段者5例、3～5个心肌节段者18例、≥6个心肌节段者11例;根据LGE透壁情况将有LGE患者分为透壁者13例和肌壁间者21例.所有患者进行门诊或电话随访,随访截至2015年10月,平均随访2.6年.记录所有患者随访期间心脏不良事件发生情况.结果 两组患者性别、年龄、完全性左束支传导阻滞发生率及使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)、β-受体阻滞剂、醛固酮拮抗剂、胺碘酮、利尿剂者所占比例比较,差异均无统计学意义(P＞0.05);观察组患者纽约心脏病协会(NYHA)分级劣于对照组,左心室射血分数(LVEF)低于对照组,使用地高辛者所占比例高于对照组(P＜0.05).观察组患者心力衰竭再住院率、室性心动过速(VT)/心室颤动(VF)发生率、心血管死亡率及心脏不良事件发生率均高于对照组(P＜0.05).与无LGE者相比,有LGE者心脏不良事件发生风险升高9.96倍[95％CI (7.17,13.87)].LGE累及3～5个心肌节段和≥6个心肌节段者心力衰竭再住院率、VT/VF发生率、心血管死亡率及心脏不良事件发生率均高于0～2个心肌节段者,累及≥6个心肌节段者心力衰竭再住院率、VT/VF发生率、心血管死亡率及心脏不良事件发生率均高于3～5个心肌节段者(P＜0.05).与LGE累及0～2个心肌节段者相比,累及3～5个心肌节段者心脏不良事件发生风险升高4.45倍[95％ CI(2.36,8.33)];与LGE累及3～5个心肌节段者相比,累及≥6个心肌节段者心脏不良事件发生风险升高5.24倍[95％CI (1.43,19.30)].有无LGE透壁患者心力衰竭再住院率、VT/VF发生率及心血管死亡率比较,差异均无统计学意义(P＞0.05);透壁者心脏不良事件发生率高于肌壁间者(P＜0.05).与肌壁间者相比,透壁者心脏不良事件发生风险升高6.05倍[95％ CI (1.31,27.94)].结论 心脏磁共振LGE及其范围和程度可在一定程度上预测DCM患者心脏不良事件的发生.