Page 85 - 南京医科大学自然版

第45卷第5期 南京医科大学学报（自然科学版）
2025年5月 Journal of Nanjing Medical University（Natural Sciences） ·671 ·

·临床研究·

心肌瘢痕与药物治疗反应对非缺血性心肌病心衰患者室性心

律失常风险的影响

计雨佳 ，张恩瑞 ，钱 雯 ，张新尉 ，朱晓梅 ，徐 怡 ，邹建刚 1*
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南京医科大学第一附属医院心血管内科，放射科，江苏 南京 210029
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［摘 要］ 目的：探究非缺血性心肌病（nonischemic cardiomyopathy，NICM）患者心肌瘢痕与药物治疗反应对室性心律失常发
生风险的影响。方法：回顾性分析在南京医科大学第一附属医院行心脏磁共振检查且接受药物治疗的 77 例左室射血分数
（left ventricular ejection fraction，LVEF）≤35%的 NICM 患者延迟钆增强（late gadolinium enhancement，LGE）与 1 年随访期内
LVEF变化情况。采用Kaplan⁃Meier曲线和Log⁃rank检验进行生存分析，多因素分析使用Cox比例风险回归。结果：中位随访
时间为 34（16~49）个月。患者药物治疗后 1 年内 LVEF 变化与 LGE 无关（P=0.379），与 LGE 负荷呈负相关，相关系数为-0.295
（95%CI：-0.487~-0.076，P=0.009）。随访期间，5例患者发生室性快速心律失常（ventricular tachyarrhythmia，VTA）事件，在生存
分析中，VTA事件与LGE负荷有关（P=0.005），与LGE是否存在和药物治疗是否有反应无关（P=0.309，P=0.890）。在多因素Cox
回归模型中，LGE 负荷是 VTA 事件的独立危险因素（HR=1.075，95%CI：1.002~1.054，P=0.043）。NICM 患者远期复合终点与
LGE负荷和LVEF 变化有关（P=0.040，P=0.025）。结论：LGE负荷是NICM 患者发生VTA 事件的独立危险因素，VTA 事件的发
生与药物治疗有无反应无关。
［关键词］ 非缺血性心肌病；左室射血分数；心肌瘢痕；延迟钆增强；室性心律失常
［中图分类号］ R542.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）05⁃671⁃07
doi： 10.7655/NYDXBNSN241434

The impact of myocardial scarring and drug treatment response on the risk of ventricular
arrhythmia in patients with nonischemic cardiomyopathy

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JI Yujia ，ZHANG Enrui ，QIAN Wen ，ZHANG Xinwei ，ZHU Xiaomei ，XU Yi ，ZOU Jiangang 1*
1 Department of Cardiology，Department of Radiology，the First Affiliated Hospital of Nanjing Medical University，
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Nanjing 210029，China
［Abstract］ Objective： To investigate the impact of myocardial scarring and drug treatment response on the risk of ventricular
arrhythmia in patients with nonischemic cardiomyopathy（NICM）. Methods：A retrospective analysis was conducted on 77 NICM
patients with left ventricular ejection fraction（LVEF）≤35% who underwent cardiac magnetic resonance with late gadolinium
enhancement（LGE）and received drug therapy at the First Affiliated Hospital of Nanjing Medical University. The changes in LVEF
during the one⁃year follow⁃up period were collected. Kaplan⁃ Meier curves and Log⁃rank tests were used for survival analysis，and
multivariate analysis was performed using Cox proportional hazards regression. Results：The median follow⁃up time was 34（16-49）
months. Changes in LVEF within one year after drug treatment were not related to LGE（P=0.379），but were negatively correlated with
LGE burden，with a correlation coefficient of -0.295（95% CI：-0.487--0.076，P=0.009）. During follow⁃up，five patients experienced
ventricular tachyarrhythmia（VTA）events. In survival analysis，VTA events were associated with LGE burden（P=0.005）but were not
related to the presence of LGE ordrug treatment response（P=0.309，P=0.890）. In the multivariate Cox regression model，LGE burden
was an independent risk factor of VTA events（HR=1.075，95%CI：1.002-1.054，P=0.043）. The long⁃term composite endpoint of
NICM patients was related to LGE burden and LVEF changes（P=0.040，P=0.025）. Conclusion：LGE burden is an independent risk
factor for the occurrence of VTA events in NICM patients，and the occurrence of VTA events is not related to drug treatment response.
［Key words］ nonischemic cardiomyopathy；left ventricular ejection fraction；myocardial scarring；late gadolinium enhancement；ven⁃
tricular arrhythmia
［J Nanjing Med Univ，2025，45（05）：671⁃677］
［基金项目］ 国家自然科学基金（82400456）
通信作者（Corresponding author），E⁃mail： jgzou@njmu.edu.cn（ORCID：0000⁃0001⁃5891⁃6589）
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