长轴缩短评估心房功能在疑似心肌炎中超越传统CMR标志物增强风险分层
该研究纳入2个三级中心符合2025年ESC「疑似心肌炎」标准且无冠心病或替代诊断的787例患者，用CMR测量左右心房长轴缩短（LAS），发现LA-LAS和RA-LAS均独立预测MACE，加入基线模型（临床变量、LVEDV、LVEF、LGE）后风险分层改善（C-index从0.72升至0.75）。
要点
- CMR测量的LA-LAS和RA-LAS可独立预测疑似心肌炎患者MACE。
- LA-LAS低于中位数22%时MACE风险显著升高（HR 2.17）。
- 在传统CMR标志物基础上加入心房LAS可改善风险分层。
关键影像表现/征象
- LA-LAS为21.5%±10.1%，RA-LAS为29.5%±12.1%。
- 随访期间17.5%的患者发生MACE。
诊断标准与关键数值
- LA-LAS每降低5%，MACE风险增加（HR 1.37；95%CI 1.23-1.52；P<0.001）。
- RA-LAS每降低5%，MACE风险增加（HR 1.27；95%CI 1.19-1.37；P<0.001）。
- LA-LAS低于中位数22%时MACE风险升高（HR 2.17；95%CI 1.33-3.57；P=0.002）。
- RA-LAS低于中位数29%时MACE风险升高（HR 1.75；95%CI 1.12-2.70；P=0.012）。
- 加入LA-LAS和RA-LAS后模型风险分层改善（卡方增加11.3；P<0.001；C-index从0.72升至0.75）。
临床应用与阅片要点
- 在疑似心肌炎CMR报告中，可考虑测量并报告LA-LAS和RA-LAS以辅助风险分层。
- 关注LA-LAS低于22%和RA-LAS低于29%的患者，其MACE风险较高。
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
BACKGROUND: Left ventricular ejection fraction (LVEF) and cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) are established risk markers for patients with myocarditis. Whether atrial functional impairment may occur in this clinical setting, and whether this finding offers incremental prognostic value, remains unknown.
OBJECTIVES: The authors sought to evaluate the association of left atrial (LA) and right atrial (RA) long axis shortening (LAS) assessed by CMR with major cardiovascular adverse events (MACE) in patients with possible myocarditis.
METHODS: Patients meeting 2025 European Society of Cardiology criteria for "possible myocarditis" undergoing CMR at 2 tertiary centers, without coronary artery disease or alternative diagnosis, were included. LAS was associated with a composite of first MACE (heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis, and all-cause mortality).
RESULTS: A total of 787 patients (age 48 ± 16 years, 36% female) were included. LA-LAS was 21.5% ± 10.1%, and RA-LAS 29.5% ± 12.1%. After a median follow-up of 3.5 years (Q1-Q3: 1.8-6.5 years), 17.5% experienced a MACE. In the univariate analysis, both LA-LAS (per 5% decrease) (HR: 1.37; 95% CI: 1.23-1.52; P < 0.001) and RA-LAS (HR: 1.27; 95% CI: 1.19-1.37; P < 0.001), were associated with MACE. In multivariable models, LA-LAS below the median (22%) (HR: 2.17; 95% CI: 1.33-3.57; P = 0.002) and RA-LAS below the median (29%) (HR: 1.75; 95% CI: 1.12-2.70; P = 0.012) both independently predicted MACE. Adding LA-LAS and RA-LAS to the baseline model (clinical variables, left ventricular end-diastolic volume, LVEF, and LGE) resulted in improved risk stratification for MACE (chi-square increase by 11.3; P < 0.001; C-index from 0.72 to 0.75).
CONCLUSIONS: Atrial dysfunction can be present in possible myocarditis and atrial LAS was independently and incrementally associated with outcomes beyond traditional CMR markers and may refine future risk stratification in this clinical setting. (CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571; Inflammatory Cardiomyopathy Bern Registry [FlamBER]; NCT04774549).
引用
- Ciocca N, Brändle D, Riederer L, et al. Atrial Function by Long Axis Shortening Enhances Risk Stratification Beyond Traditional CMR Markers in Possible Myocarditis. JACC Cardiovasc Imaging. 2026. PMID: 42207065. doi:10.1016/j.jcmg.2026.04.006
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。