瑞士伯尔尼大学医院Christoph Gräni团队，研究了心脏磁共振（CMR）成像衍生测量值与NIDCM临床预后的相关性。该研究于2024年9月19日发表在《美国医学会杂志》上。

非缺血性扩张型心肌病（NIDCM）的准确风险分层仍颇具挑战性。

为了评估心脏磁共振（CMR）成像衍生测量值与NIDCM临床结果的相关性，研究组系统地搜索了MEDLINE、Embase、Cochrane图书馆和Web of Science核心馆藏数据库中从2005年1月到2023年4月的文章。报告CMR成像衍生测量值与NIDCM不良临床预后之间关联的前瞻性和回顾性非随机诊断研究被认为是合格的。与患者群体、CMR成像测量和临床预后相关的预先指定项目由2名独立评审员在研究层面提取。随机效应模型使用限制最大似然估计和Hartung、Knapp、Sidik和Jonkman的方法进行拟合。主要结局为全因死亡率、心血管死亡率、心律失常事件、心力衰竭事件和重大不良心脏事件（MACE）。

共分析了103项研究，包括29687名NIDCM患者。晚期钆增强（LGE）的存在和程度（每1%）与较高的全因死亡率（风险比[HR]，1.81[95%CI，1.60-2.04]；P<0.001，HR，1.07[95%CI：1.02-1.12]；P=.02）、心血管死亡率（HR，2.43[95%CI，2.13-2.78]；P<0.001和HR，1.15[95%CI，1.07-1.24]；P=.01）、心律失常事件（HR，2.69[95%CI，2.20-3.30]；P<0.001，HR，1.07[95%CI，1.03-11.2]；P=.004）和心力衰竭事件（HR，1.98[95%CI，1.73-2.27]；P<0.001和HR，1.06[95%CI，1.01-1.10]；P=.02）相关。

左心室射血分数（LVEF）（每1%）与全因死亡率（HR，0.99[95%CI，0.97-1.02]；P=0.47）、心血管死亡率（HR,0.97[95%CI,0.94-1.00]；P=0.05）或心律失常结局（HR,0.99[95%CI:0.97-1.01]；P=0.34）无关。左心室射血分数越高，心力衰竭事件的风险越低（HR，0.97[95%CI，0.95-0.98]；P=0.002），MACE的风险越小（HR，0.98[95%CI；0.96-0.99]；P<0.001）。较高的自然T1弛豫时间（每10ms）与心律失常事件（HR，1.07[95%CI，1.01-1.14]；P=0.04）和MACE（HR，1.09[95%CI1.01-1.11]；P=0.03）相关。总体纵向应变（GLS）（每1%）与心力衰竭事件（HR，1.06[95%CI，0.95-1.18]；P=0.15）或MACE（HR）（1.03[95%CI,0.94-1.14]；P=0.43）无关。有限的数据排除了对自然T1弛豫时间、GLS和细胞外体积分数（ECV）与死亡率结果的明确分析。

研究结果表明，LGE的存在和程度与各种不良临床预后有关，而LVEF与NIDCM的死亡率和心律失常终点没有显著相关性。使用天然T1弛豫时间、细胞外体积分数和整体纵向应变进行风险分层需要进一步评估。

附：英文原文

Title: Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR Imaging: A Systematic Review and Meta-Analysis

Author: Christian Eichhorn, David Koeckerling, Rohin K. Reddy, Maddalena Ardissino, Marek Rogowski, Bernadette Coles, Lukas Hunziker, Simon Greulich, Isaac Shiri, Norbert Frey, Jens Eckstein, Stephan Windecker, Raymond Y. Kwong, George C. M. Siontis, Christoph Grni

Issue&Volume: 2024-09-19

Abstract:

Importance  Accurate risk stratification of nonischemic dilated cardiomyopathy (NIDCM) remains challenging.

Objective  To evaluate the association of cardiac magnetic resonance (CMR) imaging–derived measurements with clinical outcomes in NIDCM.

Data Sources  MEDLINE, Embase, Cochrane Library, and Web of Science Core Collection databases were systematically searched for articles from January 2005 to April 2023.

Study Selection  Prospective and retrospective nonrandomized diagnostic studies reporting on the association between CMR imaging–derived measurements and adverse clinical outcomes in NIDCM were deemed eligible.

Data Extraction and Synthesis  Prespecified items related to patient population, CMR imaging measurements, and clinical outcomes were extracted at the study level by 2 independent reviewers. Random-effects models were fitted using restricted maximum likelihood estimation and the method of Hartung, Knapp, Sidik, and Jonkman.

Main Outcomes and Measures  All-cause mortality, cardiovascular mortality, arrhythmic events, heart failure events, and major adverse cardiac events (MACE).

Results  A total of 103 studies including 29687 patients with NIDCM were analyzed. Late gadolinium enhancement (LGE) presence and extent (per 1%) were associated with higher all-cause mortality (hazard ratio [HR], 1.81 [95% CI, 1.60-2.04]; P<.001 and HR, 1.07 [95% CI, 1.02-1.12]; P=.02, respectively), cardiovascular mortality (HR, 2.43 [95% CI, 2.13-2.78]; P<.001 and HR, 1.15 [95% CI, 1.07-1.24]; P=.01), arrhythmic events (HR, 2.69 [95% CI, 2.20-3.30]; P<.001 and HR, 1.07 [95% CI, 1.03-1.12]; P=.004) and heart failure events (HR, 1.98 [95% CI, 1.73-2.27]; P<.001 and HR, 1.06 [95% CI, 1.01-1.10]; P=.02). Left ventricular ejection fraction (LVEF) (per 1%) was not associated with all-cause mortality (HR, 0.99 [95% CI, 0.97-1.02]; P=.47), cardiovascular mortality (HR, 0.97 [95% CI, 0.94-1.00]; P=.05), or arrhythmic outcomes (HR, 0.99 [95% CI, 0.97-1.01]; P=.34). Lower risks for heart failure events (HR, 0.97 [95% CI, 0.95-0.98]; P=.002) and MACE (HR, 0.98 [95% CI, 0.96-0.99]; P<.001) were observed with higher LVEF. Higher native T1 relaxation times (per 10 ms) were associated with arrhythmic events (HR, 1.07 [95% CI, 1.01-1.14]; P=.04) and MACE (HR, 1.06 [95% CI, 1.01-1.11]; P=.03). Global longitudinal strain (GLS) (per 1%) was not associated with heart failure events (HR, 1.06 [95% CI, 0.95-1.18]; P=.15) or MACE (HR, 1.03 [95% CI, 0.94-1.14]; P=.43). Limited data precluded definitive analysis for native T1 relaxation times, GLS, and extracellular volume fraction (ECV) with respect to mortality outcomes.

Conclusion  The presence and extent of LGE were associated with various adverse clinical outcomes, whereas LVEF was not significantly associated with mortality and arrhythmic end points in NIDCM. Risk stratification using native T1 relaxation times, extracellular volume fraction, and global longitudinal strain requires further evaluation.

DOI: 10.1001/jama.2024.13946

Source: https://jamanetwork.com/journals/jama/fullarticle/2823869