背景:为了确定使用心脏磁共振预测死亡的左心房劳损(LAS)的预后价值,心力衰竭,和缺血性卒中患者的已知或疑似冠状动脉疾病,左心室收缩功能保留且既往无缺血性卒中病史,心力衰竭,或心房颤动。
结果:本回顾性队列分析包括2017年9月至2019年12月期间转诊进行负荷心脏磁共振或心肌生存力研究的患者。左心室收缩功能受损(<50%)或有房颤史的患者,中风,或排除心力衰竭。多变量Cox模型评估了LAS的预后价值,主要结果是全因死亡的复合结果,缺血性卒中,和心力衰竭。共有2030名参与者被纳入研究。平均LAS为24.1±8.5%;928个LAS<23%,1102例LAS≥23%。平均随访时间为39.9±13.6个月。有49人死亡(2.4%),32例缺血性中风(1.6%),和34例心力衰竭事件(1.7%)。LAS<23%的患者复合结局的风险更高,调整后的风险比为2.31(95%CI,1.50-3.55)。
结论:心脏磁共振LAS对死亡具有独立和递增的预后价值,缺血性卒中,左心室收缩功能保留的患者的心力衰竭。在调整临床和心脏磁共振参数后观察到这种预后价值,包括左心室收缩功能,晚期钆增强,和左心房容积指数。
BACKGROUND: To determine the prognostic value of left atrial strain (LAS) using cardiac magnetic resonance for predicting death, heart failure, and ischemic stroke in patients with known or suspected coronary artery disease with preserved left ventricular systolic function and no prior history of ischemic stroke, heart failure, or atrial fibrillation.
RESULTS: This retrospective cohort analysis included patients referred for stress cardiac magnetic resonance or myocardial viability studies between September 2017 and December 2019. Patients with impaired left ventricular systolic function (<50%) or a history of atrial fibrillation, stroke, or heart failure were excluded. A multivariable Cox model assessed the prognostic value of LAS, with the primary outcomes being the composite outcomes of all-cause death, ischemic stroke, and heart failure. A total of 2030 participants were included in the study. The average LAS was 24.1±8.5%; 928 had LAS <23%, and 1102 had LAS ≥23%. The mean follow-up duration was 39.9±13.6 months. There were 49 deaths (2.4%), 32 ischemic strokes (1.6%), and 34 heart failure events (1.7%). Patients with LAS <23% were at greater risk for composite outcome, with an adjusted hazard ratio of 2.31 (95% CI, 1.50-3.55).
CONCLUSIONS: LAS by cardiac magnetic resonance has an independent and incremental prognostic value for death, ischemic stroke, and heart failure in patients with preserved left ventricular systolic function. This prognostic value is observed after adjusting for clinical and cardiac magnetic resonance parameters, including left ventricular systolic function, late gadolinium enhancement, and left atrial volume index.