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Extent of Late Gadolinium Enhancement Predicts Thromboembolic Events in Patients With Hypertrophic Cardiomyopathy.

晚期钆增强的程度可预测肥厚型心肌病患者的血栓栓塞事件。

  • 影响因子:2.08
  • DOI:10.1253/circj.CJ-19-0936
  • 作者列表:"Hohneck A","Overhoff D","Doesch C","Sandberg R","Rudic B","Tueluemen E","Budjan J","Szabo K","Borggrefe M","Papavassiliu T
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Thromboembolic complications such as ischemic stroke or peripheral arterial thromboembolism are known complications in hypertrophic cardiomyopathy (HCM). We sought to assess the clinical and cardiovascular magnetic resonance (CMR) characteristics of patients with HCM suffering from thromboembolic events and analyzed the predictors of these unfavorable outcomes.Methods and Results:The 115 HCM patients underwent late gadolinium enhanced (LGE) CMR and were included in the study. Follow-up was 5.6±3.6 years. The primary endpoint was the occurrence of thromboembolic events (ischemic stroke or peripheral arterial thromboembolism). It occurred in 17 (14.8%) patients (event group, EG), of whom 64.7% (11) were men. During follow-up, 10 (8.7%) patients died. Patients in the EG showed more comorbidities, such as heart failure (EG 41.2% vs. NEG (non-event group) 14.3%, P<0.01) and atrial fibrillation (AF: EG 70.6% vs. NEG 36.7%, P<0.01). Left atrial end-diastolic volume was significantly higher in the EG (EG 73±24 vs. NEG 50±33 mL/m2, P<0.01). Both the presence and extent of LGE were enhanced in the EG (extent% EG 23±15% vs. NEG 8±9%, P<0.0001). No patient without LGE experienced a thromboembolic event. Multivariate analysis revealed AF and LGE extent as independent predictors. CONCLUSIONS:LGE extent (>14.4%) is an independent predictor for thromboembolic complications in patients with HCM and might therefore be considered as an important risk marker. The risk for thromboembolic events is significantly elevated if accompanied by AF.

摘要

背景: 血栓栓塞并发症如缺血性卒中或外周动脉血栓栓塞是肥厚型心肌病 (HCM) 的已知并发症。我们试图评估患有血栓栓塞事件的 HCM 患者的临床和心血管磁共振 (CMR) 特征,并分析这些不良结局的预测因素。方法与结果: 115 例 HCM 患者接受了晚期钆增强 (LGE) CMR,纳入研究。随访 5.6 ± 3.6 年。主要终点是血栓栓塞事件 (缺血性卒中或外周动脉血栓栓塞) 的发生。发生于 17 例 (14.8%) 患者 (事件组,EG),其中 64.7% (11) 为男性。随访期间,10 例 (8.7%) 患者死亡。EG 中的患者显示出更多的合并症,如心力衰竭 (例如 41.2% vs. NEG (非事件组) 14.3%,P<0.01) 和房颤 (AF: EG 70.6% vs. NEG 36.7%,P<0.01)。左心房舒张末期容积在 EG 中显著升高 (如 73 ± 24 vs. NEG 50 ± 33 mL/m2,P<0.01)。EG 中 LGE 的存在和范围均增强 (程度 % EG 23 ± 15% vs. NEG 8 ± 9%,P<0.0001)。没有 LGE 的患者发生血栓栓塞事件。多变量分析显示 AF 和 LGE 范围是独立的预测因素。 结论: LGE 程度 (>14.4%) 是 HCM 患者血栓栓塞并发症的独立预测因子,因此可能被认为是一个重要的风险标志物。如果伴有房颤,血栓栓塞事件的风险显著升高。

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影响因子:4.69
发表时间:2020-01-07
DOI:10.1186/s12968-019-0590-z
作者列表:["Yao-Dan Liang","Yuan-Wei Xu","Wei-Hao Li","Ke Wan","Jia-Yu Sun","Jia-Yi Lin","Qing Zhang","Xiao-Yue Zhou","Yu-Cheng Chen"]

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影响因子:4.69
发表时间:2020-01-05
DOI:10.1186/s12968-019-0589-5
作者列表:["Yingxia Yang","Gang Yin","Yong Jiang","Lei Song","Shihua Zhao","Minjie Lu"]

METHODS:BACKGROUND:Atrial fibrillation (AF) is the most common arrhythmia in hypertrophic cardiomyopathy (HCM) and is associated with adverse outcomes in HCM patients. Although the left atrial (LA) diameter has consistently been identified as a strong predictor of AF in HCM patients, the relationship between LA dysfunction and AF still remains unclear. The aim of this study is to evaluate the LA function in patients with non-obstructive HCM (NOHCM) utilizing cardiovascular magnetic resonance feature tracking (CMR-FT).,METHODS:Thirty-three patients with NOHCM and 28 healthy controls were studied. The global and regional LA function and left ventricular (LV) function were compared between the two groups. The following LA global functional parameters were quantitively analyzed: reservoir function (total ejection fraction [LA total EF], total strain [ε], peak positive strain rate [SRs]), conduit function (passive ejection fraction [LA passive EF], passive strain [ε], peak early-negative SR [SRe]), and booster pump function (active ejection fraction [LA active EF], active strain [ε], peak late-negative SR [SRa]). The LA wall was automatically divided into 6 segments: anterior, antero-roof, inferior, septal, septal-roof and lateral. Three LA strain parameters (ε, ε, ε) and their corresponding strain rate parameters (SRs, SRe, SRa) during the reservoir, conduit and booster pump LA phases were segmentally measured and analyzed.,RESULTS:The LA reservoir (LA total EF: 57.6 ± 8.2% vs. 63.9 ± 6.4%, p < 0.01; ε: 35.0 ± 12.0% vs. 41.5 ± 11.2%, p = 0.03; SRs: 1.3 ± 0.4 s vs. 1.5 ± 0.4 s, p = 0.02) and conduit function (LA passive EF: 28.7 ± 9.1% vs. 37.1 ± 10.0%, p < 0.01; ε: 18.7 ± 7.9% vs. 25.9 ± 10.0%, p < 0.01; SRe: - 0.8 ± 0.3 s vs. -1.1 ± 0.4 s, p < 0.01) were all impaired in patients with NOHCM when compared with healthy controls, while LA booster pump function was preserved. The LA segmental strain and strain rate analysis demonstrated that the ε, ε, SRe of inferior, SRs, SRe of septal-roof, and SRa of antero-roof walls (all p < 0.05) were all decreased in the NOHCM cohort. Correlations between LA functional parameters and LV conventional function and LA functional parameters and baseline parameters (age, body surface area and NYHA classification) were weak. The two strongest relations were between ε and LA total EF(r = 0.84, p < 0.01), ε and LA active EF (r = 0.83, p < 0.01).,CONCLUSIONS:Compared with healthy controls, patients with NOHCM have LA reservoir and conduit dysfunction, and regional LA deformation before LA enlargement. CMR-FT identifies LA dysfunction and deformation at an early stage.

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