目的:本研究旨在探讨右心室分形维数(FD)的增量预后价值,在心律失常性心肌病(ACM)患者中通过心脏磁共振(CMR)检测心肌小梁复杂性的新标记。
方法:连续对接受CMR的ACM患者进行主要心脏事件的随访,包括心脏性猝死,心脏骤停流产,和适当的植入式心脏复律除颤器干预。通过Cox回归分析比较预后预测。我们建立了补充RVFD的多变量模型,并通过Harrell的C统计量评估了其判别。我们比较了无类别,在添加FD之前和之后,连续的净重新分类改善(cNRI)和综合辨别指数(IDI)。
结果:共有105名患者从三个中心前瞻性纳入,随访时间中位数为60(48,66)个月;记录36次主要心脏事件。小梁FD与主要心脏事件表现出强烈的未调整关联(p<0.05)。在多变量Cox回归分析中,右心室最大心尖FD与主要心脏事件保持独立关联(风险比,1.31(1.11-1.55),p<0.002)。Hosmer-Lemeshow拟合优度测试显示出良好的拟合(X2=0.68,p=0.99)。在多变量基线模型中添加RV最大根尖FD后,诊断性能显着提高。连续的净重新分类改善增加了21%(p=0.001),综合判别指数提高了16%(p=0.045)。
结论:在ACM患者中,CMR评估的心肌小梁复杂性与不良心血管事件独立相关,并提供了增量预后价值。
结论:应用FD值评估右心室心肌小梁可能成为ACM患者心血管不良事件危险因素监测和早期诊断的一个可及且有前景的参数。
结论:•心室小梁形态,一种新的CMR定量标记,首次探索确定ACM的严重程度。•RV的最大心尖分形维数较高的患者表现出显著较高的主要心脏事件累积发生率。•RV最大心尖FD与主要心脏事件独立相关,并在ACM患者中提供增量预后价值。
OBJECTIVE: The present study aimed to investigate the incremental prognostic value of the right ventricular fractal dimension (FD), a novel marker of myocardial trabecular complexity by cardiac magnetic resonance (CMR) in patients with arrhythmogenic cardiomyopathy (ACM).
METHODS: Consecutive patients with ACM undergoing CMR were followed up for major cardiac events, including sudden cardiac death, aborted cardiac arrest, and appropriate implantable cardioverter defibrillator intervention. Prognosis prediction was compared by Cox regression analysis. We established a multivariable model supplemented with RV FD and evaluated its discrimination by Harrell\'s C-statistic. We compared the category-free, continuous net reclassification improvement (cNRI) and integrated discrimination index (IDI) before and after the addition of FD.
RESULTS: A total of 105 patients were prospectively included from three centers and followed up for a median of 60 (48, 66) months; experienced 36 major cardiac events were recorded. Trabecular FD displayed a strong unadjusted association with major cardiac events (p < 0.05). In the multivariable Cox regression analysis, RV maximal apical FD maintained an independent association with major cardiac events (hazard ratio, 1.31 (1.11-1.55), p < 0.002). The Hosmer-Lemeshow goodness of fit test displayed good fit (X2 = 0.68, p = 0.99). Diagnostic performance was significantly improved after the addition of RV maximal apical FD to the multivariable baseline model, and the continuous net reclassification improvement increased 21% (p = 0.001), and the integrated discrimination index improved 16% (p = 0.045).
CONCLUSIONS: In patients with ACM, CMR-assessed myocardial trabecular complexity was independently correlated with adverse cardiovascular events and provided incremental prognostic value.
CONCLUSIONS: The application of FD values for assessing RV myocardial trabeculae may become an accessible and promising parameter in monitoring and early diagnosis of risk factors for adverse cardiovascular events in patients with ACM.
CONCLUSIONS: • Ventricular trabecular morphology, a novel quantitative marker by CMR, has been explored for the first time to determine the severity of ACM. • Patients with higher maximal apical fractal dimension of RV displayed significantly higher cumulative incidence of major cardiac events. • RV maximal apical FD was independently associated with major cardiac events and provided incremental prognostic value in patients with ACM.