The relationship between ventricular arrhythmia and myocardial characteristics in magnetic resonance imaging in patients with dilated cardiomyopathy
-
摘要: 目的 探究非缺血性扩张型心肌病(NIDCM)患者磁共振下心肌强化特征与发生室性心律失常(VA)事件的关系，找出相关危险因素。方法 将2019年11月—2021年7月于郑州大学第一附属医院就诊的154例NIDCM患者纳入研究。根据发生VA事件的情况将其分为对照组及失常组，比较两组患者的一般资料及心脏磁共振延迟强化(LGE-CMR)下心肌特征。通过logistic回归分析相关危险因素，并应用受试者工作特征(ROC)曲线分析危险因素的诊断价值。结果 失常组的左室心肌质量(LVM)低于对照组，而年龄、左室舒张末期容积(EDV)、收缩末期容积(ESV)和胺碘酮的应用人数高于对照组(P< 0.05)。LGE-CMR下失常组心肌的灰色区占比高于对照组(P< 0.05)，灰色区体积、强化区体积及占比无明显差异。logistic回归提示灰色区占比增加、年龄增大及ESV增大是发生VA的危险因素，而高LVM则为保护因素(P< 0.05)。其中灰色区占比、年龄及LVM诊断VA的曲线下面积(AUC)分别为0.662、0.646和0.607。结论 年龄和灰色区占比增大是NIDCM患者发生VA的独立危险因素，而较高的LVM起保护作用。
-
关键词:
- 室性心律失常 /
- 心脏磁共振 /
- 非缺血性扩张型心肌病 /
- 灰色区
Abstract: Objective The study was performed to explore the relationship between the characteristics of myocardial enhancement and ventricular arrhythmia(VA) in patients with non-ischemic dilated cardiomyopathy(NIDCM) by using magnetic resonance imaging, and identify relevant risk factors.Methods A total of 154 NIDCM patients in the First Affiliated Hospital of Zhengzhou University from November 2019 to July 2021 were enrolled. The patients were divided into control and arrythmia groups based on the occurrence of VA events. The basic data and myocardial characteristics in late gadolinium-enhanced cardiac magnetic resonance(LGE-CMR) of the two groups were compared. The risk factors were analyzed by logistic regression and used to analyze the diagnostic value by ROC curve.Results The left ventricular mass(LVM) in the control group was higher than that in the arrythmia group, but the age, left ventricular end diastolic volume(EDV), end systolic volume(ESV) and number of amiodarone users were lower than those in the arrythmia group(P< 0.05). Using the LGE-CMR, the proportion of gray zone in the control group was lower than that in the arrythmia group(P< 0.05), and there was no significant difference in the volume of gray zone, the volume and proportion of enhancement area(P>0.05). Logistic regression showed that the increase of age, ESV and proportion of gray zone were the risk factors of VA, while the high LVM was the protective factor. And the area under curve(AUC) of proportion of gray zone, age and LVM in VA diagnosis were 0.662, 0.646 and 0.607 respectively.Conclusion The increase in age and the proportion of gray zone are independent risk factors for VA in NIDCM patients, and higher LVM plays a protective role. -
-
图 1 左心室心肌强化识别与划分
Figure 1. Recognition and division of left ventricular myocardial enhancement
图 2 NIDCM患者VA风险因素的ROC曲线
Figure 2. The ROC curve of risk factors of ventricular arrhythmia in NIDCM patients
表 1 两组患者一般资料比较
Table 1. Comparison of basic data between the two groups
X±S, M(P25, P75) 项目 对照组(66例) 失常组(88例) t/Z/χ2值 P值 男/例(%) 53(80.30) 65(73.86) 0.873 0.350 年龄/岁 47.56±13.98 54.16±11.19 -3.151 0.002 身高/cm 171.92±9.35 170.53±7.68 0.809 0.421 体重/kg 76.20±17.11 73.01±13.50 1.227 0.222 糖尿病史/例(%) 8(12.12) 8(9.10) 0.372 0.542 吸烟史/例(%) 25(37.88) 30(34.10) 0.236 0.627 饮酒史/例(%) 20(30.30) 28(31.82) 0.040 0.841 HbA1c/% 5.81(5.60，6.33) 6.0(5.64，6.50) -1.108 0.268 TC/(mmol·L-1) 4.04±0.87 3.80±0.90 1.621 0.107 TG/(mmol·L-1) 1.21(0.87，1.84) 1.17(0.89，1.55) -0.900 0.368 HDL-C/(mmol·L-1) 0.99(0.83，1.17) 1.00(0.82，1.20) -0.210 0.834 LDL-C/(mmol·L-1) 2.55±0.78 2.41±0.72 1.156 0.250 Hb/(g·L-1) 148.00(133.50，163.50) 142.45(133.25，151.43) -1.864 0.062 K/(mmol·L-1) 4.30±0.51 4.29±0.57 0.113 0.910 Na/(mmol·L-1) 141.00(139.65，143.00) 141.00(139.00，142.80) -1.017 0.309 Ca/(mmol·L-1) 2.31(2.23，2.38) 2.32(2.22，2.36) -0.897 0.369 SCr/(μmol·L-1) 81.50(69.83，94.83) 79.00(67.70，90.00) -0.967 0.334 UA/(μmol·L-1) 379.00(316.50，476.00) 370.00(315.25，464.75) -0.586 0.558 TBil/(μmol·L-1) 12.73(9.53，18.46) 13.06(9.10，19.03) -0.343 0.732 ALB/(g·L-1) 41.00(38.15，44.45) 40.60(38.40，43.60) -0.616 0.538 NT-proBNP/(ng·L-1) 933.70(470.00，2273.75) 1147.00(398.58，3421.00) -1.102 0.270 GFR/[mL·min-1·(1.73m2)-1] 92.80(76.79，104.18) 90.76(76.82，101.07) -1.080 0.280 药物应用情况/例(%) β受体阻滞剂 59(89.40) 80(90.91) 0.098 0.754 螺内酯 62(93.94) 81(92.05) 0.204 0.652 呋塞米 54(81.82) 70(79.55) 0.124 0.725 ACEI/ARB类 59(89.40) 84(95.45) 2.089 0.148 他汀类 34(51.52) 38(43.18) 1.052 0.305 地高辛 23(34.85) 28(31.82) 0.156 0.693 胺碘酮 4(6.06) 20(22.73) 7.963 0.005 ACEI/ARB：血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂 
下载: 导出CSV
表 2 比较两组间磁共振下心肌特征
Table 2. Evaluating the myocardial characteristics between two groups by using CMR
X±S 项目 对照组(66例) 失常组(88例) t/χ2值 P值 EF/% 26.90±9.74 24.58±10.62 1.390 0.166 EDV/mL 273.86±107.19 327.80±192.85 -2.200 0.029 ESV/mL 204.99±95.63 255.86±168.16 -2.363 0.019 SV/mL 71.29±23.41 72.04±35.89 -0.143 0.887 CO/(L·min-1) 5.37±2.08 5.48±3.14 -0.232 0.817 LVM/g 190.76±62.84 171.48±49.21 2.029 0.044 无强化图像数/例(%) 9(13.64) 12(13.64) 0.000 1.000 灰色区体积/cm3 8.37±6.76 9.76±5.79 -1.272 0.206 灰色区占比/% 34.54±12.63 42.81±15.48 -3.292 0.001 总强化区体积/cm3 24.62±16.49 24.62±15.59 -0.002 0.999 总强化区占比/% 16.76±9.08 19.27±11.54 -1.360 0.176
下载: 导出CSV
表 3 NIDCM患者VA风险因素的多因素logistic回归分析
Table 3. Multivariate logistic regression results of VA risk factors for NIDCM patients
变量 β SE OR 95%CI P值 年龄 0.036 0.017 1.036 1.003~1.070 0.031 ESV 0.011 0.003 1.011 1.005~1.017 0.001 LVM -0.018 0.006 0.982 0.971~0.993 0.002 灰色区占比 0.039 0.017 1.039 1.006~1.073 0.019 常量 -2.123 1.346 0.120
下载: 导出CSV
-
[1] 中华医学会心血管病学分会, 中国心肌炎心肌病协作组. 中国扩张型心肌病诊断和治疗指南[J]. 临床心血管病杂志, 2018, 34(5): 421-434.
[2] Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy[J]. N Engl J Med, 2000, 342(15): 1077-1084. doi: 10.1056/NEJM200004133421502
[3] Gulati A, Jabbour A, Ismail TF, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy[J]. JAMA, 2013, 309(9): 896-908. doi: 10.1001/jama.2013.1363
[4] Nelson T, Garg P, Clayton RH, et al. The Role of cardiac MRI in the management of ventricular arrhythmias in ischaemic and non-ischaemic dilated cardiomyopathy[J]. Arrhythm Electrophysiol Rev, 2019, 8(3): 191-201. doi: 10.15420/aer.2019.5.1
[5] Shenasa M. Fibrosis and ventricular arrhythmogenesis: role of cardiac MRI[J]. Card Electrophysiol Clin, 2019, 11(3): 551-562. doi: 10.1016/j.ccep.2019.06.002
[6] Disertori M, Masè M, Ravelli F. Myocardial fibrosis predicts ventricular tachyarrhythmias[J]. Trends Cardiovasc Med, 2017, 27(5): 363-372. doi: 10.1016/j.tcm.2017.01.011
[7] 王璐静, 姜安谧, 金富伟, 等. CMR量化评价心肌梗死周围边缘带预测室性心律失常的研究进展[J]. 临床心血管病杂志, 2021, 37(6): 585-588. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202106019.htm
[8] 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 2020室性心律失常中国专家共识(2016共识升级版)[J]. 中华心律失常学杂志, 2020, 24(3): 111-115. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXZ202003002.htm
[9] Institute SCaI. "Seg3D" Volumetric Image Segmentation and Visualization. Scientific Computing and Imaging Institute(SCI). Available at: http://www.seg3d.org.
[10] Schindelin J, Arganda-Carreras I, Frise E, et al. An open-source platform for biological-image analysis[J]. Nat Methods, 2012, 9(7): 676-682. doi: 10.1038/nmeth.2019
[11] Gouda S, Abdelwahab A, Salem M, et al. Scar characteristics for prediction of ventricular arrhythmia in ischemic cardiomyopathy[J]. Pacing Clin Electrophysiol, 2015, 38(3): 311-318. doi: 10.1111/pace.12536
[12] Schultheiss HP, Fairweather D, Caforio A, et al. Dilated cardiomyopathy[J]. Nat Rev Dis Primers, 2019, 5(1): 32. doi: 10.1038/s41572-019-0084-1
[13] Becker M, Cornel JH, van de Ven PM, et al. The Prognostic value of late gadolinium-enhanced cardiac magnetic resonance imaging in nonischemic dilated cardiomyopathy: a review and meta-analysis[J]. JACC Cardiovasc Imaging, 2018, 11(9): 1274-1284. doi: 10.1016/j.jcmg.2018.03.006
[14] Willis MS, Yates CC, Schisler JC. Fibrosis in Disease: An Organ-Based Guide to Disease Pathophysiology and Therapeutic Considerations[J]. Springer, 2018: 111.
[15] Berruezo A, Jáuregui B, Penela D. Towards an improved and personalized risk stratification of sudden cardiac death in dilated non-ischaemic cardiomyopathy: is the time for ejection fraction coming to an end?[J]. Eur Heart J Cardiovasc Imaging, 2021, 22(10): 1139-1141. doi: 10.1093/ehjci/jeab147
[16] Stecker EC, Vickers C, Waltz J, et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction[J]. JACC, 2006, 47(6): 1161-1166. doi: 10.1016/j.jacc.2005.11.045
[17] Mandawat A, Chattranukulchai P, Mandawat A, et al. Progression of myocardial fibrosis in nonischemic DCM and association with mortality and heart failure outcomes[J]. JACC Cardiovasc Imaging, 2021, 14(7): 1338-1350. doi: 10.1016/j.jcmg.2020.11.006
[18] Centurión OA, Alderete JF, Torales JM, et al. Myocardial fibrosis as a pathway of prediction of ventricular arrhythmias and sudden cardiac death in patients with nonischemic dilated cardiomyopathy[J]. Crit Pathw Cardiol, 2019, 18(2): 89-97. doi: 10.1097/HPC.0000000000000171
[19] Barison A, Grigoratos C, Todiere G, et al. Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance[J]. Heart Fail Rev, 2015, 20(6): 731-749. doi: 10.1007/s10741-015-9509-4
[20] Balaban G, Halliday BP, Bai W, et al. Scar shape analysis and simulated electrical instabilities in a non-ischemic dilated cardiomyopathy patient cohort[J]. PLoS Comput Biol, 2019, 15(10): e1007421. doi: 10.1371/journal.pcbi.1007421
[21] Chen Z, Sohal M, Voigt T, et al. Myocardial tissue characterization by cardiac magnetic resonance imaging using T1 mapping predicts ventricular arrhythmia in ischemic and non-ischemic cardiomyopathy patients with implantable cardioverter-defibrillators[J]. Heart Rhythm, 2015, 12(4): 792-801. doi: 10.1016/j.hrthm.2014.12.020
[22] Pham VT, Lin C, Tran TT, et al. Predicting ventricular tachyarrhythmia in patients with systolic heart failure based on texture features of the gray zone from contrast-enhanced magnetic resonance imaging[J]. J Cardiol, 2020, 76(6): 601-609. doi: 10.1016/j.jjcc.2020.06.020
[23] Estner HL, Zviman MM, Herzka D, et al. The critical isthmus sites of ischemic ventricular tachycardia are in zones of tissue heterogeneity, visualized by magnetic resonance imaging[J]. Heart Rhythm, 2011, 8(12): 1942-1949. doi: 10.1016/j.hrthm.2011.07.027
[24] Oduneye SO, Pop M, Shurrab M, et al. Distribution of abnormal potentials in chronic myocardial infarction using a real time magnetic resonance guided electrophysiology system[J]. Journal of cardiovascular magnetic resonance, 2015, 17(1): 27. doi: 10.1186/s12968-015-0133-1
-
图(2)
表(3)
计量
- 文章访问数: 1391
- PDF下载数: 351
- 施引文献: 0