【摘要】 目的：探究心脏磁共振成像（CMR）定量参数初始纵向弛豫时间（T1）和细胞外体积分数（ECV）与肥厚型心肌病（HCM）患者主要不良心血管事件（MACE）的关联及风险分层价值。方法：本项回顾性队列研究连续纳入2018年1月至2025年1月于云南省第一人民医院就诊的HCM患者192例。所有参与者均接受CMR检查，采集初始及增强T1定量成像（T1 mapping）图像计算ECV；应用钆延迟增强（LGE）评估纤维化负荷。随访记录MACE（包括心血管死亡、埋藏式心脏复律除颤器合理放电、心脏移植、心肌梗死、因心力衰竭住院）。比较发生与未发生MACE患者的临床及影像学特征，采用Cox比例风险回归分析评估初始T1与MACE的相关性。结果：中位随访54(42)个月，共29例（15.1%）患者发生MACE。多因素Cox比例风险回归分析显示，全局初始T1(HR=1.534,95%CI:1.159～1.801,P<0.001)及非持续性室性心动过速（NSVT,HR=4.379,95%CI:1.981～12.005,P<0.001）与MACE发生独立相关。结合全局初始T1可显著提高临床风险因素对MACE的区分能力（Harrell’s C-指数由0.74提升至0.79,P<0.05）。结论：全局初始T1升高是HCM患者发生MACE的独立风险因素。初始T1及ECV作为定量影像标志物，有助于在传统临床评估基础上进一步优化患者的风险分层。更多还原

【Abstract】 Objectives: To evaluate the association and risk stratification value of cardiac magnetic resonance imaging(CMR)-derived native T1 mapping and extracellular volume fraction(ECV) for major adverse cardiovascular events(MACE) in patients with hypertrophic cardiomyopathy(HCM).Methods: This retrospective cohort study consecutively enrolled 192 HCM patients at the First People’s Hospital of Yunnan Province. All participants underwent CMR with native and post-contrast T1 mapping to calculate ECV. Fibrosis burden was assessed by late gadolinium enhancement(LGE). MACE included cardiovascular death, appropriate implantable cardioverter-defibrillator(ICD) therapy, heart transplantation, myocardial infarction, and hospitalization due to heart failure. Clinical and imaging characteristics were compared between patients with and without MACE. Cox proportional hazards models were used to evaluate the association between native T1 and adverse prognosis. Results: During a median follow-up of 54(42) months, 29 patients(15.1%) experienced MACE. Multivariable Cox proportional hazards analysis identified that global native T1(HR=1.534, 95%CI: 1.159-1.801, P<0.001) and non-sustained ventricular tachycardia(NSVT, HR=4.379, 95%CI: 1.981-12.005, P<0.001) were independent risk factors associated with MACE. Incorporating global native T1 into the baseline clinical model(NSVT and conventional European Society of Cardiology risk factors) improved the Harrells’ C-index from 0.74 to 0.79(P<0.05). Conclusions: Elevated global native T1 is an independent risk factor for MACE in HCM patients. As quantitative imaging markers, native T1 and ECV help optimize risk stratification beyond traditional clinical assessment.更多还原