心脏磁共振左房室耦联指数预测扩张型心肌病左室逆重构
回顾性纳入64例接受指南导向药物治疗的扩张型心肌病患者，随访一年按超声标准分为左室逆重构（LVRR）组与非LVRR组，构建分别整合LACI、左房应变或左室应变的多变量模型。LACI为LVRR独立预测因子（OR=0.585，95%CI 0.391-0.874，P=0.009），整合LACI的联合模型AUC=0.825，优于整合左室应变（AUC=0.805）或左房应变（AUC=0.791）的模型。
要点
- LACI是DCM患者LVRR的独立预测因子，OR=0.585。
- 整合LACI的联合模型预测LVRR的AUC为0.825。
- LACI模型预测效能优于左室应变或左房应变模型。
核心结论
- 在临床和常规CMR参数基础上整合LACI预测DCM患者LVRR，效能与应变参数相当或更优。
研究设计与样本
- 回顾性研究，纳入64例接受指南导向药物治疗的住院DCM患者，随访一年。
- 以超声心动图标准将患者分为LVRR组与非LVRR组。
- 基于单变量分析（p<0.2）筛选预测因子，构建分别整合LACI、左房应变或左室应变的多变量模型，用Delong检验比较模型性能。
关键影像表现/征象
- LVRR组LACI、血清肌酐、尿酸及所有心脏容积参数（左室和左房容积）均显著更低（均p<0.05）。
- LVRR组左室和左房射血分数、所有左室应变及所有左房应变均显著更高（均p<0.05）。
诊断标准与关键数值
- LACI预测LVRR的独立预测因子OR=0.585（95%CI 0.391-0.874，p=0.009）。
- 整合LACI的联合模型AUC=0.825，整合左室应变模型AUC=0.805，整合左房应变模型AUC=0.791。
临床应用与阅片要点
- 在DCM患者CMR评估中可测量LACI，辅助预测标准化药物治疗后左室逆重构。
- LACI可作为应变参数之外的补充指标，整合入临床和常规CMR参数模型提升预测效能。
局限性
- 回顾性研究，样本量64例，单中心，结论需更大样本验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
AIM: To investigate the value of the cardiac magnetic resonance (CMR)-derived left atrioventricular coupling index (LACI) in predicting left ventricular reverse remodeling (LVRR) in patients with dilated cardiomyopathy (DCM) receiving standardized medical therapy.
MATERIALS AND METHODS: This retrospective study enrolled 64 hospitalized DCM patients managed with guideline-directed therapy. Within a one-year follow-up, patients were stratified into LVRR and non-LVRR groups using echocardiographic criteria. Three multivariable models were constructed from predictors identified in univariable analysis (p<0.2), each uniquely integrating either the LACI, left atrial strain, or left ventricular strain. The Delong test was used to compare model performance.
RESULTS: In our study, the LVRR group exhibited significantly lower LACI, serum creatinine, uric acid, and all cardiac volumetric parameters (left ventricular and atrial volumes) (all p<0.05). Conversely, the LVRR group showed higher left ventricular and atrial ejection fractions, all left ventricular strains, and all left atrial strains (all p<0.05). LACI was an independent predictor of LVRR (odds ratio = 0.585; 95% confidence interval [CI]: 0.391-0.874; p=0.009). The combined model incorporating LACI demonstrated the best predictive performance, with an area under the curve (AUC) of 0.825, outperforming the models incorporating left ventricular strain (AUC = 0.805) or left atrial strain (AUC = 0.791).
CONCLUSION: For predicting LVRR in DCM, LACI provides value comparable to or superior to than strain parameters when incorporated into models based on clinical and conventional CMR parameters.
引用
- Ke J, Zhang C, Wang X, et al. Cardiac magnetic resonance-derived atrioventricular coupling index for predicting left ventricular reverse remodeling in dilated cardiomyopathy. Clin Radiol. 2026. PMID: 42155308. doi:10.1016/j.crad.2026.107368
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。