医学
心脏病学
内科学
心肌病
室致密化不全
心力衰竭
扩张型心肌病
心脏移植
临床终点
冲程容积
移植
心脏磁共振成像
磁共振成像
射血分数
放射科
随机对照试验
作者
Emre Demir,Selen Bayraktaroğlu,Akın Çinkooğlu,Aytaç Candemir,Yeşim B. Candemir,Rıza O Öztürk,Ömer Faruk Dadaş,Mehmet Orman,Mehdi Zoghi,Azem Akıllı,Naim Ceylan,Cemil Gürgün,Sanem Nalbantgil
摘要
Abstract Aims Left ventricular non‐compaction cardiomyopathy (LVNC) is a poorly understood entity resulting in heart failure. Whether it is a distinct form of cardiomyopathy or an anatomical phenotype is a subject of discussion. The current diagnosis is based on morphologic findings by comparing the compacted to non‐compacted myocardium. The study aimed to compare demographic and prognostic variables of patients with dilated cardiomyopathy (DCM) and LVNC. Emphasis was given to cardiac magnetic resonance (CMR) imaging analysis. Data on survival were also assessed. Methods and results We retrospectively evaluated the characteristics and outcomes of 262 non‐ischaemic cardiomyopathy patients with LVNC and DCM phenotypes. Petersen's CMR criteria of non‐compacted to the compacted myocardial ratio 2.3 were used to diagnose LVNC. The primary endpoint was a composite endpoint of major adverse cardiovascular events comprising cardiovascular‐related death, left ventricular assisted device implantation, or heart transplantation. A total of 262 patients with CMR data were included in the study. One hundred fifty‐five patients who fulfilled CMR criteria were diagnosed as LVNC. CMR findings revealed that LVNC patients had higher left ventricular end‐diastolic (137.2 ± 51.6, 116.8 ± 44.6, P = 0.002) and systolic volume index (98.4 ± 49.5, 85.9 ± 42.7, P = 0.049). Cardiac haemodynamics, cardiac output (5.61 ± 2.03, 4.96 ± 1.83; P = 0.010), stroke volume (73.9 ± 28.8, 65.1 ± 25.1; P = 0.013), and cardiac index (2.85 ± 1.0, 2.37 ± 0.72; P < 0.0001), were higher in LVNC patients. Of all the 249 patients, 102 (40.9%) patients demonstrated late gadolinium enhancement (LGE). According to Petersen's criteria, the Kaplan–Meier survival outcome did not reveal significant differences (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: [0.89–2.63], P = 0.11). The presence or pattern of LGE did not show significant importance for endpoint‐free survival. Most of the sub‐epicardial LGE pattern was found in LVNC patients (94.4%). When receiver operator characteristics analysis was applied to NC/C ratio to discriminate the primary endpoint, a higher NC/C ratio of 2.57 was associated with adverse events (HR: 1.90, 95% CI: [1.12–3.24], P = 0.016). Conclusions Our study questions the criteria being used for the diagnosis of LVNC. Further evaluation of CMR variables and association of these findings with demographic variables and survival is mandatory.
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