科普知识学英语 心肌病患者心肌受损易引发死亡

海量资料下载 免费学习英语 www.englishvip.com/xinlw.htm （申请网址） Detection of midwall fibrosis（纤维化） (the presence of scar tissue in the middle of the heart muscle wall) via magnetic resonance imaging among patients with nonischemic dilatedcardiomyopathy（扩张型心肌病） (a condition affecting the heart muscle) was associated with an increased likelihood of death, according to a study appearing in the March 6 issue of JAMA. Nonischemic dilated cardiomyopathy is associated with significant illness and death due to progressive heart failure (HF) and sudden cardiac death (SCD). Despite therapeutic advances, 5-year mortality remains as high as 20 percent. "Risk stratification of patients with nonischemic dilated cardiomyopathy is primarily based on left ventricular ejection fraction [LVEF; a measure of how well the left ventricle of the heart pumps with each contraction]. Superiorprognostic（预兆的） factors may improve patient selection for implantable cardioverter-defibrillators (ICDs) and other management decisions," according to background information in the article. Attention has recently focused on whether detection of myocardial（心肌的）replacement fibrosis (scarring of the heart muscle) may assist with risk stratification（层理）in dilated cardiomyopathy. Fibrosis is associated with contractile impairment.   Ankur Gulati, M.D., of Royal Brompton Hospital, London, and colleagues evaluated whether midwall fibrosis (detected by late gadolinium enhancement cardiovascular magnetic resonance [LGE-CMR] imaging) predicts risk of death, independently of LVEF and other established prognostic factors in dilated cardiomyopathy. The study included 472 patients with dilated cardiomyopathy referred to a U.K. center for CMR imaging between November 2000 and December 2008 after presence and extent of midwall replacement fibrosis (scarring of the heart muscle present in the middle of the heart muscle wall) were determined. Patients were followed up through December 2011.   During a median (midpoint) follow-up of 5.3 years, there were 73 deaths. Overall, 38 of 142 patients with midwall fibrosis (26.8 percent) died compared with 35 of 330 patients without midwall fibrosis (10.6 percent). After analysis, both the presence and percentage extent of midwall fibrosis were significant independent predictors of all-cause mortality. The arrhythmic composite end point (SCD or aborted SCD) occurred in 65 patients (14 percent). Analysis indicated that patients with midwall fibrosis were more than 5 times more likely to experience SCD or aborted SCD compared with patients without midwall fibrosis (29.6 percent vs. 7.0 percent).   "After adjustment for LVEF and other conventional prognostic factors, both the presence of fibrosis and the extent were independently and incrementally associated with all-cause mortality. Fibrosis was also independently associated with cardiovascular mortality or cardiac transplantation, SCD or aborted SCD, and the HF composite [HF death, HF hospitalization, or cardiac transplantation]," the authors write.   Also, the addition of fibrosis to LVEF significantly improved risk reclassification for all-cause mortality and the SCD composite.   "Our findings suggest that detection and quantification of midwall fibrosis by LGE-CMR may represent useful markers for the risk stratification of death, ventricular arrhythmia, and HF for patients with dilated cardiomyopathy," the researchers write. 检测间隔壁上纤维化（纤维化）（疤痕组织的存在下在中间的心脏肌肉壁）通过磁共振成像的患者中与非缺血性扩张型心肌病（扩张型心肌病）（一条件影响心脏的肌肉）是与死亡的可能性增加，根据一项研究显示，在3月6日的JAMA。非缺血性扩张型心肌病是由于累进心脏衰竭（HF）和心脏性猝死（SCD）的重大疾病和死亡相关。尽管治疗进展，5年死亡率仍高达20％。“危险分层与非缺血性扩张型心肌病的患者主要是基于左室射血分数[LVEF;如何衡量心脏左心室泵每次收缩。高级预后（预兆的）因素可能提高患者植入式选择心脏复律除颤器（ICD）以及其他管理决定“，根据背景文章中的信息。最近将注意力集中在是否检测心肌（心肌的）替代性纤维化（疤痕的心脏肌肉）可能有助于风险分层（层理），扩张型心肌病。纤维化收缩减值是与。   ANKUR古拉蒂博士，伦敦皇家布朗普顿医院，和同事评估是否间隔壁上纤维化（检测年底钆增强[LGE-CMR心血管磁共振成像）独立预测死亡风险​​，扩张型心肌病的LVEF和其他既定的预后因素。该研究纳入472例患者后，2000年11月至2008年12月到英国CMR成像中心的存在和程度的的更换间隔壁上纤维化（疤痕的心脏肌肉中存在的心脏肌壁的中间）乃与扩张型心肌病。术后随访2011年12月通过。   在中位数（中点）随访5.3年，有73人死亡。总体而言，38与35 330例无间隔壁上纤维化（10.6％）相比，的间隔壁上纤维化142例（26.8％）死于。经过分析，存在和百分比的间隔壁上纤维化程度的各种原因的死亡率显着的独立预测因素。心律失常的复合终点（SCD或中止SCD）发生65例（14％）。分析表明，间隔壁上纤维化患者更有可能体验到SCD或中止SCD与无间隔壁上纤维化的患者（29​​.6％比7.0％）相比，5倍以上。   “LVEF和其他传统的预后因素调整后，独立并逐步纤维化的存在和程度伴有各种原因的死亡率纤维化与心血管死亡率或心脏移植，SCD或中止SCD独立相关，HF复合[HF死亡，心衰住院，或心脏移植，“作者写道。   此外，将肝纤维化与LVEF显着改善了风险重新分类为各种原因的死亡率和SCD复合。   “我们的研究结果表明，LGE-CMR的间隔壁上纤维化的检测和定量可能代表有用的标记与扩张型心肌病的患者死亡，室性心律失常和HF的危险分层，”研究人员写道。 “成千上万人疯狂下载。。。。。。 更多价值连城的绝密英语学习资料， 洛基内部秘密英语，技巧，策略 请在 网上 申请报名” 洛基国际英语 竭诚为您服务