延迟增强心肌磁共振定量分析对缺血性心肌病患者室性心律失常预测价值

Quantification analysis by delayed enhancement cardiovascular magnetic resonance imaging predicts ventricular arrhythmias in patients with ischemic cardiomyopathy

目的探索延迟增强心脏磁共振成像(DE-CMR)定量分析对缺血性心肌病患者发生室性心律失常的预测价值。方法 41例缺血性心肌病伴有左心室射血分数≤35%的患者在植入心脏转复除颤器(ICD)前进行DE-CMR检查,对心肌延迟增强定量分析,并对ICD定期程控记录室性心律失常发生情况。结果在平均(441±209)d随访中,12例(29%)患者ICD)记录到自发或治疗终止的持续性室性心动过速或心室颤动。发生室性心律失常患者的增强心肌质量及其占左心室心肌质量百分比均显著高于无室性心律失常组[(60.1±24.4)g比(40.9±20.1)g,P=0.01)及(51.8%±20.0%)比(37.8%±15.2%),P=0.02]。受试者工作特征曲线(ROC)分析显示增强心肌质量或其百分比对室性心律失常预测价值高于射血分数。在多因素分析中,增强心肌质量(HR 1.54/10 g;95%CI1.06～2.45,P=0.02)或其百分比(HR 1.65/10%;95%CI 1.05～2.58;P=0.03)是惟一的发生室性心律失常预测因子。结论 DE-CMR定量分析是预测缺血性心肌病患者发生室性心律失常的独立危险因子。

Objective To explore the utility of delayed enhancement cardiac CMR （DE-CMR） for prediction of ventricular arrhythmias in patients with ischemie cardiomyopathy. Methods A total of 41 consecutive patients with ischemic cardiomyopathy and severely impaired left ventricular function （ejection fraction ≤35% ） underwent DE-CMR before implantation of implantable cardioverter-defibrillator （ICD）, and were prospectively followed for ventricular arrhythmias by interrogation of the devices. Results During mean follow-up of （441 ±209） days, 12 （29%） patients had documented sustained ventricular tachycardia or ventrlcular fibrillation terminated spontaneously or by ICD appropriate therapy. Enhanced myocardium mass and the percentage out of total left ventricle mass were significantly greater in patients with ventricular arrhythmias than in those without [ （60. 1 ±24. 4）g vs. （40. 9 ±20. 1 ）g,P =0. 01 and （51.8% ±20. 0% ） vs. （37.8% ±15.2% ）, P =0. 02]. In receive operating characteristic （ROC） curve analysis enhanced myocm＇dium mass or percentage showed superiority to ejection fraction. Enhanced myocardium mass or percentage was the sole predictor of ventricular arrhythmias in multivariate analysis （ HR 1.54/10 g; 95% CI 1.06-2.45 ; P = 0. 02 and HR 1.65/10% ; 95% CI 1.05-2. 58 ; P =0. 03, respectively）. Conclusions Enhanced myocardium quantified by DE-CMR was an independent predictor of ventricular arrhythmias in patients with cardiomyopathy.