基于CMR-LGE图像的左心室熵对肥厚型心肌病患者MACE的预测研究
Prediction of MACE in Patients with Hypertrophic Cardiomyopathy by Left Ventricular Entropy Based on CMR-LGE Image
郑月 1马运婷 1沙立辉 1赵新湘1
作者信息
- 1. 650101 昆明医科大学第二附属医院放射科
- 折叠
摘要
目的 探讨基于心脏磁共振成像(CMR)-钆延迟强化(LGE)图像获得的左心室熵能否预测肥厚型心肌病(HCM)患者主要心脏不良事件(MACE)的发生风险.方法 选取2018年1月至2021年12月符合HCM诊断标准且具有CMR检查的患者,以MACE为终点事件.根据随访结果将患者分为MACE组和无MACE组,采用CVI42心脏后处理软件测得左心室射血分数(LVEF),将LGE图像导入Python 3.8软件获得左心室熵.结果 最终纳入107例HCM患者,中位随访为23个月,其中MACE组34例,无MACE组73例.MACE组左心房内径(LAD)[(39.14±6.85)mm vs.(35.24±7.70)mm]、左心室最大室壁厚度(LVMWT)[(21.18±4.37)mm vs.(19.23± 3.11)mm]、左心室熵[5.12(3.94,6.18)vs.4.04(2.64,5.45)]均大于无 MACE 组(P均＜0.05);MACE 组 LVEF[(53.54±14.94)％vs.(59.64±10.95)％]小于无 MACE 组(P=0.038).单因素 Logistic 回归显示,LAD、LVM-WT、LVEF、左心室熵是发生MACE的危险因素,进一步多因素回归显示,LVEF(OR=0.960,95％CI:0.927～0.995,P=0.026)、左心室熵(OR=1.600,95％CI:1.148～2.229,P=0.006)是 HCM 发生 MACE 的独立危险因素.受试者工作特征(ROC)曲线显示,LVEF单变量预测模型的曲线下面积(AUC)为0.637,最佳截断值为52.41％,敏感度为41.18％,特异度为84.93％;左心室熵单变量预测模型的AUC为0.692,最佳截断值为4.975,敏感度为61.76％,特异度为71.23％.左心室熵和LVEF联合预测模型的AUC为0.721.结论 基于CMR-LGE图像获得的左心室熵可反映心肌的异质性,是HCM患者预后的有效预测因子,HCM患者发生MACE的风险随左心室熵的增大而增加,有助于为HCM患者提供更全面的危险分层,提高患者预后.
Abstract
Objective To investigate whether left ventricular entropy based on MR-LGE image can predict the risk of major cardiac adverse events(MACE)in patients with hypertrophic cardiomyopathy(HCM).Methods Patients who met the diagnostic criteria of HCM and had cardiac magnetic resonance(CMR)examination from January 2018 to December 2021 were selected,with MACE as the endpoint event.According to the follow-up results,the patients were divided into the MACE group and the non-MACE group.The left ventricular ejection fraction(LVEF)was measured by CVI42 cardiac post-processing software,and the LGE image was imported into Python 3.8 software to obtain the left ventricular entropy.Re-sults A total of 107 HCM patients were included,with a median follow-up of 23 months,including 34 patients in the MACE group and 73 patients without MACE.The inner diameter of left atrium(LAD)in MACE group[(39.14±6.85)mm vs.(35.24±7.70)mm],maximum left ventricular Maximum wall thickness(LVMWT)[(21.18±4.37)vs.(19.23±3.11)],and left ventricular entropy[5.12(3.94,6.18)vs.4.04(2.64,5.45)]were higher than those without MACE(all P＜0.05);The LVEF of MACE group[(53.54±14.94)％vs.(59.64±10.95)％]was lower than that of non-MACE group(P=0.038).Single logistic regression showed that LAD,LVMWT,LVEF and left ventricular entropy were the risk factors for MACE.Further multi-factor regression showed that LVEF(OR=0.960,95％CI:0.927-0.995,P=0.026)and left ventricular entropy(OR=1.600,95％CI:1.148-2.229,P=0.006)were independent risk factors for MACE in HCM.Receiver Operating characteristic(ROC)curve showed that the area under the curve(AUC)of LVEF uni-variate prediction model was 0.637,the optimal cut-off value was 52.41％,the sensitivity was 41.18％,and the specificity was 84.93％.The AUC of the single variable prediction model of left ventricular entropy was 0.692,the optimal cut-off val-ue was 4.975,the sensitivity was 61.76％,and the specificity was 71.23％.The AUC of the combined prediction model of left ventricular entropy and LVEF was 0.721.Conclusion Left ventricular entropy based on CMR-LGE image can reflect myocardial heterogeneity and is an effective predictor of prognosis in HCM patients.The risk of MACE in HCM patients in-creases with the increase of left ventricular entropy,which is helpful to provide a more comprehensive risk stratification for HCM patients and improve the prognosis of patients.
关键词
肥厚型心肌病/磁共振成像/纹理分析/熵/左心室/主要心脏不良事件Key words
Hypertrophic cardiomyopathy/Magnetic resonance imaging/Texture analysis/Entropy/Left ventricle/Major cardiac adverse events引用本文复制引用
基金项目
国家自然科学基金(82160332)
北京医学奖励基金会课题研究项目(YXJL-2022-0665-0214)
云南省重点项目(202203AC10007)
云南省重点项目(202201AY070001-097)
昆医附二院院内临床研究项目(yn11T2021010)
出版年
2024
NETL
NSTL
万方数据