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Myocardial Extracellular Volume Fraction Adds Prognostic Information Beyond Myocardial Replacement Fibrosis.
Circulation: Cardiovascular Imaging ( IF 7.5 ) Pub Date : 2019-12-16 , DOI: 10.1161/circimaging.119.009535
Eric Y Yang 1 , Mohamad G Ghosn 1 , Mohammad A Khan 1 , Nickalaus L Gramze 1 , Gerd Brunner 1, 2 , Faisal Nabi 1 , Vijay Nambi 1, 2, 3 , Sherif F Nagueh 1 , Duc T Nguyen 1 , Edward A Graviss 1 , Erik B Schelbert 4 , Christie M Ballantyne 1, 2 , William A Zoghbi 1 , Dipan J Shah 1
Affiliation  

BACKGROUND Cardiac magnetic resonance techniques permit quantification of the myocardial extracellular volume fraction (ECV), representing a surrogate marker of reactive interstitial fibrosis, and late gadolinium enhancement (LGE), representing replacement fibrosis or scar. ECV and LGE have been independently linked with heart failure (HF) events. In deriving ECV, coronary artery disease type LGE, but not non-coronary artery disease type LGE, has been consistently excluded. We examined the associations between LGE, global ECV derived from myocardial tissue segments free of any detectable scar, and subsequent HF events. METHODS Mid short-axis T1 maps were divided into 6 cardiac segments, each classified as LGE absent or present. Global ECV was derived from only segments without LGE. ECV was considered elevated if >30%, the upper 95% bounds of a reference group without known cardiac disease (n=28). Patients were divided into 4 groups by presence of elevated ECV and of any LGE. Subsequent HF hospitalization and any death were ascertained. Their relationship with ECV was examined separately and as a composite with Cox proportional hazard models. RESULTS Of 1604 serial patients with T1 maps, 1255 were eligible after exclusions and followed over a median 26.3 (interquartile range, 15.9-37.5) months. Patients with elevated ECV had increased risk for death (hazard ratio [HR] 2.45 [95% CI, 1.76-3.41]), HF hospitalization (HR, 2.45 [95% CI, 1.77-3.40]), and a combined end point of both outcomes (HR, 2.46 [95% CI, 1.94-3.14]). After adjustments for covariates including LGE, the relationship persisted for death (HR, 1.82 [95% CI, 1.28-2.59]), hospitalization (HR, 1.60 [95% CI, 1.12-2.27]), and combined end points (HR, 1.73 [95% CI, 1.34-2.24]). CONCLUSIONS ECV measures of diffuse myocardial fibrosis were associated with HF outcomes, despite exclusion of replacement fibrosis segments from their derivation and even among patients without any scar. ECV may have a synergistic role with LGE in HF risk assessment.

中文翻译:

心肌细胞外体积分数增加了心肌替代纤维化之外的预后信息。

背景技术心脏磁共振技术允许量化心肌细胞外体积分数(ECV),代表反应性间质纤维化的替代标志物,和晚期钆增强(LGE),代表替代纤维化或瘢痕。ECV 和 LGE 与心力衰竭 (HF) 事件独立相关。在推导 ECV 时,一直排除冠状动脉疾病类型 LGE,而不是非冠状动脉疾病类型 LGE。我们检查了 LGE、源自无任何可检测疤痕的心肌组织段的全局 ECV 与随后的 HF 事件之间的关联。方法 中短轴 T1 图分为 6 个心脏节段,每个节段分类为 LGE 不存在或存在。全球 ECV 仅来自没有 LGE 的部分。如果 >30%,则认为 ECV 升高,没有已知心脏病的参考组的上限 95% (n=28)。根据 ECV 升高和任何 LGE 的存在将患者分为 4 组。确定随后的 HF 住院和任何死亡。它们与 ECV 的关系被单独检查,并作为与 Cox 比例风险模型的复合材料进行检查。结果 在 1604 名具有 T1 图的系列患者中,1255 名在排除后符合条件,并且中位随访时间超过 26.3(四分位距,15.9-37.5)个月。ECV 升高的患者死亡风险增加(风险比 [HR] 2.45 [95% CI, 1.76-3.41])、心衰住院(HR, 2.45 [95% CI, 1.77-3.40])和综合终点两种结果(HR,2.46 [95% CI,1.94-3.14])。在对包括 LGE 在内的协变量进行调整后,死亡 (HR, 1.82 [95% CI, 1.28-2.59])、住院治疗 (HR, 1. 60 [95% CI, 1.12-2.27])和综合终点(HR, 1.73 [95% CI, 1.34-2.24])。结论 弥漫性心肌纤维化的 ECV 测量与 HF 结局相关,尽管排除了替代纤维化节段的推导,甚至在没有任何疤痕的患者中。ECV 可能与 LGE 在 HF 风险评估中具有协同作用。
更新日期:2019-12-17
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