摘要
目的探讨联合多个心脏磁共振(CMR)高危特征对左心室射血分数(LVEF)轻度降低或保留的ST段抬高型心肌梗死(STEMI)患者心室重构的预测价值。方法本研究为前瞻性队列研究。选取2019年10月至2021年9月于北京安贞医院接受直接经皮冠状动脉介入治疗(PCI)后,急性期LVEF>40%的STEMI患者。所有患者完成急性期(术后3~7 d)及恢复期(术后3个月)2次CMR检查。按照是否发生心室重构,将患者分为心室重构组和无心室重构组。收集并比较两组患者的基本临床特征和CMR指标,采用logistic回归和受试者工作特征(ROC)曲线进行分析,筛选出预测心室重构的CMR高危特征。分析联合多个CMR高危特征对LVEF轻度降低或保留的STEMI患者心室重构的预测价值,并与传统临床危险因素模型进行比较。结果共纳入123例STEMI患者,年龄(57.1±11.1)岁,男性102例(82.9%),无心室重构组97例(78.9%),心室重构组26例(21.1%)。多因素logistic回归筛选出心室重构的5个CMR高危特征:每搏输出量(SV)<51.6 ml、整体周向应变(GCS)>-13.7%、梗死面积>39.2%、微循环障碍(MVO)>0.5%以及心肌挽救指数(MSI)<43.9。STEMI患者CMR高危特征的个数越多,则心室重构的发生率越高(P<0.01)。合并≥3个CMR高危特征是LVEF轻度降低或保留的STEMI患者发生心室重构的独立预测因素(OR=5.95,95%CI:2.25~15.72,P<0.01)。与传统临床危险因素模型相比,结合CMR高危特征个数能够提供增量预测价值(曲线下面积0.843比0.696,P<0.01)。结论在LVEF轻度降低或保留的STEMI患者中,5项CMR特征与心室重构发生相关,合并≥3个CMR高危特征是心室重构的独立预测因素,其具有传统危险因素以外的增量预测价值。
Objective To evaluate the predictive value of a multiparametric cardiac magnetic resonance(CMR)approach for ventricular remodeling in ST-segment-elevation myocardial infarction(STEMI)patients with mildly reduced or preserved left ventricular ejection fraction(LVEF).Methods This study is a prospective cohort study.STEMI patients with acute LVEF>40%after primary percutaneous coronary intervention(PCI)in Beijing Anzhen Hospital from October 2019 to September 2021 were enrolled.All patients received acute(3-7 days)and follow-up(3 months)CMR post-PCI.According to absence or presence of ventricular remodeling,patients were divided into ventricular remodeling group and non-ventricular remodeling group.Basic clinical characteristics and CMR indicators were analyzed and compared between the two groups.Logistic regression and receiver operating characteristic(ROC)curves were used to explore the predictive performance of CMR high-risk attributes for ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF.The predictive value of combining multiple high-risk characteristics of CMR for ventricular remodeling was analyzed and compared with the traditional clinical risk factor model.Results A total of 123 STEMI patients were enrolled(aged(57.1±11.1)years,102(82.9%)males).There were 97 cases(78.9%)patients in the non-ventricular remodeling group and 26 cases(21.1%)in the ventricular remodeling group.After adjustment for clinical risk factors,stroke volume<51.6 ml,global circumferential strain>-13.7%,infarct size>39.2%,microvascular obstruction>0.5%,and myocardial salvage index<43.9 were independently associated with ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF.The incidence of ventricular remodeling increased with the increasing number of CMR high-risk attributes(P<0.01).The number of CMR high-risk attributes≥3 was an independent predictor of adverse remodeling(adjusted OR=5.95,95 CI%:2.25-15.72,P<0.01)in STEMI patients with mildly reduced or preserved LVEF.Furthermore,t
作者
郭倩
王晓
郭芮丰
郭影影
严研
公威
郑文
王辉
徐磊
艾辉
阙斌
聂绍平
Guo Qian;Wang Xiao;Guo Ruifeng;Guo Yingying;Yan Yan;Gong Wei;Zheng Wen;Wang Hui;Xu Lei;Ai Hui;Que Bin;Nie Shaoping(Center for Coronary Artery Disease,Division of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China;Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2022年第9期864-872,共9页
Chinese Journal of Cardiology
基金
国家重点研发计划(2020YFC2004800)
北京市自然科学基金(7222046,7191002)
北京市科技新星项目(Z201100006820087)
北京市科技新星计划交叉学科合作课题(Z211100002121165)。
关键词
心肌梗死
心脏磁共振
心室重构
Myocardial infarction
Cardiovascular magnetic resonance
Ventricular remodeling
