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首页> 外文期刊>The American Journal of Cardiology >Comparison Between Echocardiography and Cardiac Magnetic Resonance Imaging in Predicting Transplant-Free Survival After the Fontan Operation
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Comparison Between Echocardiography and Cardiac Magnetic Resonance Imaging in Predicting Transplant-Free Survival After the Fontan Operation

机译：超声心动图和心脏磁共振成像在丰坦手术后预测无移植存活率方面的比较

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摘要

Adverse outcomes increase in frequency as patients after Fontan operation approach adulthood. Cardiac magnetic resonance (CMR) imaging derived parameters have been shown to predict death/transplant; however, limited data are available on the usefulness of echocardiography in risk stratification. We conducted a retrospective, single-center review of records of patients after Fontan operation with an echocardiogram and CMR within 1 year of each other. The primary end point was time to all-cause mortality or listing for transplant. Of the 127 eligible patients, there were 12 end points (9%; 10 deaths and 2 listing for transplant). Median age was 16.8 years (interquartile range 12 to 23.1) with a median follow-up of 3.8 years (interquartile range 2.6 to 5.7). Among clinical parameters, protein-losing enteropathy had the strongest association with the outcome. Among echocardiographic variables, global circumferential strain showed the strongest association (hazard ratio 1.3 per unit change, 95% confidence interval 1.1 to 1.5, p value 0.001, C-index 0.81), whereas among CMR variables indexed ventricular end-diastolic volume showed the strongest association with the outcome (hazard ratio 1.04 per 10 ml/BSA(1.3) increase in volume, 95% confidence interval 1.02 to 1.06, p value 0.001, C-index 0.82). Cox proportional hazards analysis revealed echocardiography and CMR models to each individually have a higher predictive ability than the clinical model; however, in direct comparison, neither technique was superior. In conclusion, both echocardiography-derived circumferential strain and CMR-derived ventricular end-diastolic volume index are associated with transplant-free survival in patients after Fontan operation. Echocardiography and CMR parameters have higher discriminative ability than clinical variables. Although neither imaging technique is superior in this cohort, both introduce important factors for risk stratification. (C) 2015 Elsevier Inc. All rights reserved.
机译：丰坦手术后的患者成年后不良结局的频率会增加。心脏磁共振（CMR）成像得出的参数已显示出可以预测死亡/移植的数据;但是，关于超声心动图在危险分层中的作用的可用数据有限。我们对丰坦手术后的患者记录进行了回顾性，单中心回顾，彼此之间在1年内进行了超声心动图和CMR检查。主要终点是所有原因的死亡率或需要移植的时间。在127名合格患者中，有12个终点（9％; 10例死亡和2例移植）。中位年龄为16.8岁（四分位间距为12至23.1），中位随访时间为3.8年（四分位间距为2.6至5.7）。在临床参数中，蛋白质丢失性肠病与结局之间的关联最强。在超声心动图变量中，总体周向应变显示出最强的关联性（每单位变化的危险比1.3、95％的置信区间1.1至1.5，p值0.001，C指数0.81），而在CMR变量中，以心室舒张末期容积指数最高与结果相关（风险比每10 ml / BSA（1.3）增加1.04,95％置信区间1.02至1.06，p值0.001，C指数0.82）。 Cox比例风险分析显示，超声心动图和CMR模型对每个个体的预测能力均高于临床模型;但是，直接比较，这两种技术都不是上乘的。总之，Fontan手术后患者的超声心动图来源的圆周应变和CMR来源的心室舒张末期容积指数均与无移植生存期相关。超声心动图和CMR参数比临床变量具有更高的判别能力。尽管在这一队列中，两种成像技术都没有优势，但两者均引入了风险分层的重要因素。 （C）2015 Elsevier Inc.保留所有权利。

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