Ringlike late gadolinium enhancement provides incremental prognostic value in non-classical arrhythmogenic cardiomyopathy.

IF 4.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2023-11-30 DOI:10.1186/s12968-023-00986-1

Yuelong Yang, Xiaoyu Wei, Guanyu Lu, Jiajun Xie, Zekun Tan, Zhicheng Du, Weitao Ye, Huanwen Xu, Xiaodan Li, Entao Liu, Qianhuan Zhang, Yang Liu, Jinglei Li, Hui Liu

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Abstract

Background: The 2019 arrhythmogenic right ventricular cardiomyopathy (ARVC) risk model has proved insufficient in the capability of predicting ventricular arrhythmia (VA) risk in non-classical arrhythmogenic cardiomyopathy (ACM). Furthermore, the prognostic value of ringlike late gadolinium enhancement (LGE) of the left ventricle in non-classical ACM remains unknown. We aimed to assess the incremental value of ringlike LGE over the 2019 ARVC risk model in predicting sustained VA in patients with non-classical ACM.

Methods: In this retrospective study, consecutive patients with non-classical ACM who underwent CMR from January 2011 to January 2022 were included. The pattern of LGE was categorized as no, non-ringlike, and ringlike LGE. The primary outcome was defined as the occurrence of sustained VA. Univariable and multivariable Cox regression analysis was used to evaluate the impact of LGE patterns on sustained VA and area under curve (AUC) was calculated for the incremental value of ringlike LGE.

Results: A total of 73 patients were collected in the final cohort (mean age, 39.3 ± 14.4 years, 51 male), of whom 10 (13.7%) had no LGE, 33 (45.2%) had non-ringlike LGE, and 30 (41.1%) had ringlike LGE. There was no statistically significant difference in the 5-year risk score among the three groups (P = 0.190). During a median follow-up of 34 (13-56) months, 34 (46.6%) patients experienced sustained VA, including 1 (10.0%), 13 (39.4%) and 20 (66.7%) of patients with no, non-ringlike and ringlike LGE, respectively. After multivariable adjustment, ringlike LGE remained independently associated with the presence of sustained VA (adjusted hazard ratio: 6.91, 95% confidence intervals: 1.89-54.60; P = 0.036). Adding ringlike LGE to the 2019 ARVC risk model showed significantly incremental prognostic value for sustained VA (AUC: 0.80 vs. 0.67; P = 0.024).

Conclusion: Ringlike LGE provides independent and incremental prognostic value over the 2019 ARVC risk model in patients with non-classical ACM.

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环形晚期钆增强对非经典心律失常性心肌病的预后有增加价值。

背景:2019年致心律失常性右室心肌病(ARVC)风险模型被证明在预测非经典致心律失常性心肌病(ACM)患者室性心律失常(VA)风险方面能力不足。此外，非经典ACM左心室环形晚期钆增强(LGE)的预后价值尚不清楚。我们的目的是评估环样LGE相对于2019年ARVC风险模型在预测非经典ACM患者持续VA方面的增量价值。方法:在这项回顾性研究中，纳入了2011年1月至2022年1月连续接受CMR治疗的非经典ACM患者。LGE类型分为无、非环状和环状LGE。主要终点定义为持续VA的发生，采用单变量和多变量Cox回归分析评估LGE模式对持续VA的影响，并计算曲线下面积(AUC)作为环状LGE的增量值。结果:最终队列共收集73例患者(平均年龄39.3±14.4岁，男性51例)，其中无LGE 10例(13.7%)，非环样LGE 33例(45.2%)，环样LGE 30例(41.1%)。三组患者5年风险评分比较，差异无统计学意义(P = 0.190)。在中位随访34(13-56)个月期间，34例(46.6%)患者出现持续的VA，其中1例(10.0%)，13例(39.4%)和20例(66.7%)患者分别为无、非环状和环状LGE。多变量校正后，环状LGE仍与持续VA存在独立相关(校正风险比:6.91,95%置信区间:1.89-54.60;p = 0.036)。在2019年ARVC风险模型中加入环状LGE，对持续性VA的预后价值显著增加(AUC: 0.80 vs. 0.67;p = 0.024)。结论:环样LGE在非经典ACM患者的2019 ARVC风险模型中提供独立且递增的预后价值。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.