磁共振成像2026，Vol.17Issue(8)：80-87,205,9.DOI:10.12015/issn.1674-8034.2026.08.008
基于CMR分析标准化心外膜脂肪体积对扩张型心肌病左室逆向重构的预测价值
Predictive value of normalized epicardial adipose tissue volume for left ventricular reverse remodeling in dilated cardiomyopathy based on CMR
摘要
Abstract
Objective:To investigate the predictive value of epicardial adipose tissue(EAT)parameters derived from cardiac magnetic resonance(CMR)for left ventricular reverse remodeling(LVRR)in patients with dilated cardiomyopathy(DCM).Materials and Methods:A total of 73 patients with DCM treated at Yijishan Hospital of Wannan Medical University from May 2023 to July 2025 were retrospectively enrolled.Clinical data,echocardiographic parameters,and CMR-derived parameters including cardiac functional parameters,EAT thickness,epicardial adipose tissue volume(EATV),and late gadolinium enhancement(LGE)percentage(LEG％)were collected.All patients received guideline-directed medical therapy and were followed up by echocardiography for 12 months.Patients were divided into the LVRR and non-LVRR groups according to the occurrence of LVRR.Baseline clinical and CMR data were compared between the two groups.Variables with statistically significant differences in univariate analysis(P＜0.05),except for normalized EATV and LGE extent LGE％,were entered into stepwise logistic regression to construct the baseline model(Model 1).Normalized EATV and LGE％were then separately added to Model 1 to construct Model 2 and Model 3,respectively.Finally,both normalized EATV and LGE％were added to construct the combined model.The area under the receiver operating characteristic curve(AUC)was calculated for each model,and predictive performance was compared using the DeLong test.Spearman correlation analysis and mediation analysis were used to explore the relationship between EAT indices and LGE％.Results:At baseline,the LVRR group had a higher proportion of women and a higher body mass index,whereas left ventricular end-diastolic volume(LVEDV),left ventricular end-diastolic volume index(LVEDVi),left ventricular end-systolic volume(LVESV),right ventricular free wall(RVFW)thickness,EATV,normalized EATV,and LGE％were all significantly lower than those in the non-LVRR group(all P＜0.05).After adjustment for potential confounders,stepwise multivariate logistic regression analysis identified female sex(P=0.019),normalized EATV(P=0.010),and LGE％(P=0.023)as independent predictors of LVRR.The AUCs of Model 1,Model 2,Model 3,and the combined model for predicting LVRR were 0.765,0.857,0.856,and 0.891,respectively.DeLong test showed that Model 2(P=0.028),Model 3(P=0.043),and the combined model(P=0.018)all demonstrated significantly better predictive performance than Model 1,whereas no significant differences were observed among Model 2,Model 3,and the combined model(all P＞0.05).Correlation analysis showed that EATV and normalized EATV were significantly positively correlated with LGE％(r=0.613 and 0.624,respectively;both P＜0.001).Mediation analysis demonstrated that LGE％partially mediated the association between normalized EATV and LVRR,with a mediation proportion of 39.10％(P=0.030).Conclusions:Normalized EATV is an independent predictor for LVRR in patients with DCM,and its effect is partially mediated by promoting myocardial fibrosis.Quantitative EAT parameters and LGE％obtained from one-stop CMR imaging may serve as objective imaging markers for treatment response and prognostic stratification in patients with DCM.关键词
扩张型心肌病/心外膜脂肪/晚期钆增强/左室逆向重构/心脏磁共振Key words
dilated cardiomyopathy/epicardial adipose tissue/late gadolinium enhancement/left ventricular reverse remodeling/cardiac magnetic resonance分类
医药卫生引用本文复制引用
王馨苒,许雯,张超,柯洁,程亮,吴琛,姚宇恒,周运锋..基于CMR分析标准化心外膜脂肪体积对扩张型心肌病左室逆向重构的预测价值[J].磁共振成像,2026,17(8):80-87,205,9.基金项目
Beijing Medical Award Foundation Project(No.YXJL-2024-0350-0282,YXJL-2024-0350-0281) （No.YXJL-2024-0350-0282,YXJL-2024-0350-0281）
Natural Science Research Project of Anhui Provincial Department of Education(No.2023AH040251,2024AH051921). 北京医学奖励基金会项目(编号:YXJL-2024-0350-0282、YXJL-2024-0350-0281) （No.2023AH040251,2024AH051921）
安徽省教育厅自然科学研究项目(编号:2023AH040251、2024AH051921) （编号:2023AH040251、2024AH051921）
