肥厚型心肌病左房室耦联指数评估：CMR改善风险分层
该回顾性研究纳入2240例肥厚型心肌病患者，评估CMR衍生的左房室耦联指数（LACI）对心脏性猝死事件的预测价值。平均随访4.0±2.5年，128例（5.7%）发生SCD事件。LACI可独立预测SCD事件，且在指南模型基础上加入LACI和LGE可提高AUC和特异度。
要点
- LACI定义为左房舒张末期容积与左室舒张末期容积之比，可从CMR获得。
- LACI可独立预测HCM患者SCD事件，独立于LGE和传统危险因素。
- 在ESC指南模型中加入LACI和LGE可提高风险分层的AUC和特异度。
关键影像表现/征象
- 发生SCD事件的患者LACI更高（39%±28% vs 33%±23%，P=0.04）。
- 发生SCD事件的患者LGE更显著（12.1±8.6% vs 6.4±4.3%，P<0.001）。
- 发生SCD事件的患者LVEF更低（48±15% vs 65±13%，P<0.001）。
诊断标准与关键数值
- LACI定义为左房舒张末期容积与左室舒张末期容积之比。
- 在多变量模型中，校正LGE和传统危险因素后，LACI独立预测SCD事件（HR 1.44-1.46，95%CI 1.3-1.6，P<0.001）。
- 在ESC模型中加入LACI和LGE后，AUC从0.53提高至0.69，特异度从57.9%提高至82.6%。
临床应用与阅片要点
- 在HCM患者的CMR报告中，可考虑测量并报告LACI，以辅助SCD风险分层。
- LACI联合LGE可提高指南模型的风险预测性能，尤其改善特异度。
局限性
- 回顾性研究设计。
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 assess the prognostic value of the left atrioventricular coupling index (LACI) in predicting sudden cardiac death (SCD) events in patients with hypertrophic cardiomyopathy (HCM), and to evaluate whether LACI provides incremental prognostic information beyond guideline-based risk models.
MATERIALS AND METHODS: In this retrospective study, 2,240 HCM patients were analysed. Clinical and cardiac magnetic resonance (CMR) parameters, including LACI, late gadolinium enhancement (LGE), and left ventricular ejection fraction (LVEF), were evaluated. LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Univariable and multivariable Cox regression analyses assessed associations of LACI with SCD events and guideline-based models (European Society of Cardiology [ESC] and American College of Cardiology/American Heart Association [ACC/AHA]).
RESULTS: Over a mean follow-up of 4.0 ± 2.5 years, 128 patients (5.7%) experienced SCD events. Event patients had higher LACI (39% ± 28% vs. 33% ± 23%, P = 0.04), greater LGE (12.1 ± 8.6% vs 6.4 ± 4.3%, P < 0.001), and lower LVEF (48 ± 15% vs 65 ± 13%, P < 0.001). LACI independently predicted SCD events after adjusting for LGE and conventional risk factors (multivariable hazard ratio [HR] 1.44-1.46, 95% confidence interval [CI]: 1.3-1.6; P < 0.001) in both ESC- and ACC/AHA-adjusted models. Adding LACI and LGE to the ESC model improved the area under the curve [AUC] (0.69 vs 0.53) and specificity (82.6% vs 57.9%).
CONCLUSION: CMR-derived LACI independently predicts adverse outcomes in HCM and provides incremental prognostic value beyond LGE and guideline-based models.
引用
- Zhang D, Qian Y, Gu Z, et al. Assessment of left atrioventricular coupling index in hypertrophic cardiomyopathy: improving risk stratification with cardiac magnetic resonance (CMR). Clin Radiol. 2026. PMID: 42176596. doi:10.1016/j.crad.2026.107369
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。