肌心炎临床和成像诊断标准的预后影响
Benedikt Bernhard1, Martin E Marxer2, Jan C Zurkirchen2
1Department of Cardiology, University Hospital Bern, Bern, Switzerland; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Journal of the American College of Cardiology
|October 2, 2024
概括
欧洲心脏病学会 (ESC) 的标准是有效的诊断心肌炎和预测患者的结果. 更新的Lake-Louise标准 (LLC) 也显示出预后价值,强调了临床和心脏MRI发现的重要性.
科学领域:
- 心脏病学 心脏病学
- 医学诊断 医学诊断 医学诊断
- 心脏成像 - - 心脏成像
背景情况:
- 目前的心肌炎的诊断标准在主要的心脏病学会之间有所不同.
- 这些不同标准的预后影响以前没有被比较过.
研究的目的:
- 为了比较欧洲心脏病学会 (ESC) 标准的诊断和预后价值,更新的湖路易斯标准 (LLC),美国心脏协会 (AHA) 可能的急性心肌炎 (pAM) 标准,以及急性心肌炎 (AM) 和复杂心肌炎 (CM) 的专家共识标准.
主要方法:
- 分析了一组1050名怀疑心肌炎的患者和现有的心磁共振 (CMR) 数据.
- 没有其他诊断的患者被评估是否遵守各种心肌炎诊断标准.
- 评估了诊断标准与不良综合结果 (心力衰竭住院,心肌炎复发,持续的心室动脉冲动或死亡) 之间的关联.
主要成果:
- 大多数患者 (89.3%) 符合ESC标准,而较少的患者满足LCL (28.5%),pAM (33.9%),AM (20.6%),或CM (7.3%).
- 副作用发生在15.3%的患者中,平均随访时间为3.4年.
- 对于不良结果,ESC标准和LLC显示出最强的独立和增量预测值,而LLC显示出最高的事件率 (6.6%).
结论:
- 与LLC相比,ESC标准在现实世界中识别出更大比例的心肌炎患者.
- 无论是ESC还是LLC标准,都具有显著的独立预后价值.
- 将临床评估 (ESC标准) 与CMR发现 (LLC) 整合在一起,对于准确的心肌炎诊断和风险分层至关重要.
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