心肌ECV对已知或疑似冠心病患者死亡与心衰的预测价值
本研究为回顾性队列研究，纳入因心肌缺血或存活评估接受心脏磁共振的已知或疑似冠心病患者2214例。采用改良Look-Locker反转恢复序列行T1 mapping并计算细胞外容积分数ECV。中位随访约41个月显示ECV可预测复合终点、全因死亡和心力衰竭，提示其可用于危险分层。
要点
- ECV升高与死亡和心衰风险增加相关，可作为冠心病危险分层参考指标
- ECV高于中位数28.23%者预后更差，报告时应关注T1 mapping ECV数值
- 该指标为间质纤维化相关参数，阅片时需结合患者冠脉病变背景解读
核心结论
- ECV是已知或疑似冠心病患者不良临床结局的有价值预测指标。
- ECV可用于已知或疑似冠心病患者的危险分层。
研究设计与样本
- 回顾性队列研究，纳入2017至2019年因临床评估心肌缺血或存活接受CMR的患者2214例。
- 采用改良Look-Locker反转恢复协议行native T1和对比剂增强后T1 mapping。
- 主要临床结局为死亡和心力衰竭发生，采用Cox比例风险模型分析预测因素。
关键影像表现/征象
- 研究未报告与ECV异常直接对应的具体影像征象，仅提供T1 mapping衍生的ECV数值分布特征。
诊断标准与关键数值
- 研究人群平均ECV为28.87±5.17%，中位数为28.23%，四分位间距为25.91%至31.05%。
- 以中位数分组，1107例ECV高于中位数，1107例ECV低于或等于中位数。
- ECV对复合结局、全因死亡和心力衰竭的校正后风险比分别为1.99（95%CI 1.32-3.00，P<0.001）、1.91（95%CI 1.13-3.25，P=0.016）和1.94（95%CI 1.03-3.63，P=0.041）。
临床应用与阅片要点
- 对已知或疑似冠心病患者行CMR评估时，可计算并报告ECV，辅助预后分层。
- ECV高于中位数的患者可能需更密切随访或更积极的二级预防管理。
- 阅片时ECV参数应结合T1 mapping图像质量和患者临床背景综合判断。
局限性
- 本研究为回顾性队列设计。
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
BACKGROUND: Extracellular volume (ECV) fraction measured by cardiac magnetic resonance (CMR) is an indicator of interstitial fibrosis and has demonstrated prognostic significance. This study aimed to assess the prognostic value of ECV in patients with known or suspected coronary artery disease.
METHODS: This retrospective cohort study included patients who underwent CMR for clinical assessment of myocardial ischemia or viability between 2017 and 2019. Native and post-contrast T1 mapping was performed using the modified look-locker inversion protocol. Primary clinical outcomes were mortality and heart failure onset. The Cox proportional hazards model was employed to analyze predictors of clinical outcomes.
RESULTS: A total of 2214 patients were included in the study. Their mean age was 68.7 ± 12.8 years, and 54.6% (1208 patients) were female. The mean ECV was 28.87 ± 5.17%, with a median value of 28.23% (interquartile range 25.91-31.05). Among the patients, 1107 (50%) had ECV values above the median, while 1107 (50%) had an ECV below the median. During a mean follow-up duration of 41.2 ± 13.2 months, 71 patients (3.2%) died, and 58 (2.6%) patients developed heart failure. ECV was found to be a predictor of composite outcomes, all-cause mortality, and heart failure, with adjusted hazard ratios and 95% confidence intervals of 1.99 (1.32-3.00, P < 0.001), 1.91 (1.13-3.25, P = 0.016), and 1.94 (1.03-3.63, P = 0.041), respectively.
CONCLUSIONS: ECV is a valuable marker for predicting adverse clinical outcomes in patients with known or suspected coronary artery disease and may be useful for the risk stratification.
引用
- Krittayaphong, Jirataiporn, Yindeengam, et al. Predictive value of myocardial extracellular volume fraction for mortality and heart failure in known or suspected coronary artery disease patients. Eur J Radiol. 2026. PMID: 42258919. doi:10.1016/j.ejrad.2026.112982
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。