心脏磁共振对扩张型心肌病患者左心室逆重构的评估价值OACSTPCD

Objective To investigate the value of cardiac magnetic resonance(CMR)in evaluating left ventricular reverse remodeling(LVRR)in patients with dilated cardiomyopathy(DCM).Methods A total of 112 DCM patients diagnosed and treated in Ya'an People's Hospital from June 2017 to June 2020 were selected.All enrolled patients underwent computed tomographic angiography(CTA)or selective coronary angiography to exclude coronary heart disease,and completed 24-hour dynamic electrocardiography,echocardiography and late gadolinium enhancement cardiac magnetic resonance(LGE-CMR).Subsequently,optimal medical therapy(OMT)was given according to the guidelines.Relevant data were recorded during a 12-month follow-up,including general information of enrolled patients,echocardiographic parameters,LVRR,changes in LGE(△LGE score),changes in left ventricular ejection fraction(△LVEF),and cardiac events.The correlation between LGE parameters and LVRR was analyzed.Results Among 112 DCM patients,28 patients(25%)experienced LVRR during follow-up.These patients had higher heart rate,higher systolic blood pressure,and lower NYHA cardiac function grade at baseline(χ2=3.357,2.161,35.012;P<0.01).LGE positive rate and LGE score in patients with LVRR were significantly lower compared with those in patients without LVRR(χ2/t=5.829,2.831;P<0.05).The△LGE score of patients with LVRR(-3.1±2.7)%was lower than that of patients without LVRR(4.4±2.1)%,the difference was statistically significant(t=7.343,P<0.01).During follow-up,△LVEF was negatively correlated with △LGE score(r=-0.781,P<0.01).Multivariate analysis showed LGE positivity,baseline LGE score,△ LGE score were protective factors for LVRR(OR=0.233,0.773,0.901;P<0.05).The incidence of cardiac events in LGE-positive patients was significantly higher than that in LGE-negative patients(χ2=47.998,P<0.05).Patients who experienced cardiac events had higher baseline LGE score and △LGE score compared to those who did not experience cardiac events(t=26.960,14.930;P<0.01).Conclusion In DCM patients,baseline LGE-CMR positivity,score and△LGE score are protective factors for LVRR.The incidence of cardiac events in LGE-positive patients is significantly higher than that in LGE-negative patients.Follow-up CMR contributes to the early formulation of individualized treatment strategies.