南方医科大学学报2024，Vol.44Issue(3)：553-562,10.DOI:10.12122/j.issn.1673-4254.2024.03.17
心脏磁共振成像对急性ST段抬高型心肌梗死后左心室不良重构的预测价值
Predictive value of cardiac magnetic resonance imaging for adverse left ventricular remodeling after acute ST-segment elevation myocardial infarction
摘要
Abstract
Objective To assess the value of cardiac magnetic resonance(CMR)imaging for predicting adverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction(STEMI).Methods We retrospectively analyzed the clinical data and serial CMR(cine and LGE sequences)images of 86 STEMI patients within 1 week and 5 months after percutaneous coronary intervention(PCI),including 25 patients with adverse LV remodeling and 61 without adverse LV remodeling,defined as an increase of left ventricular end-systolic volume(LVESV)over 15%at the second CMR compared to the initial CMR.The CMR images were analyzed for LV volume,infarct characteristics,and global and infarct zone myocardial function.The independent predictors of adverse LV remodeling following STEMI were analyzed using univariate and multivariate Logistic regression methods.Results The initial CMR showed no significant differences in LV volume or LV ejection fraction(LVEF)between the two groups,but the infarct mass and microvascular obstructive(MVO)mass were significantly greater in adverse LV remodeling group(P<0.05).Myocardial injury and cardiac function of the patients recovered over time in both groups.At the second CMR,the patients with adverse LV remodeling showed a significantly lower LVEF,a larger left ventricular end-systolic volume index(LVESVI)and a greater extent of infarct mass(P<0.001)with lower global peak strains and strain rates in the radial,circumferential,and longitudinal directions(P<0.05),infarct zone peak strains in the 3 directions,and infarct zone peak radial and circumferential strain rates(P<0.05).The independent predictors for adverse LV remodeling following STEMI included the extent of infarct mass(AUC=0.793,95%CI:0.693-0.873;cut-off value:30.67%),radial diastolic peak strain rate(AUC=0.645,95%CI:0.534-0.745;cut-off value:0.58%),and RAAS inhibitor(AUC= 0.699,95%CI:0.590-0.793).Conclusion The extent of infarct mass,peak radial diastolic strain rate,and RAAS inhibitor are independent predictors of adverse LV remodeling following STEMI.关键词
左心室不良重构/急性ST段抬高型心肌梗死/心脏磁共振/心脏磁共振特征追踪/心肌应变Key words
adverse left ventricular remodeling/ST-segment elevation myocardial infarction/cardiac magnetic resonance/cardiac magnetic resonance feature-tracking/myocardium strain引用本文复制引用
崔佳宁,刘文佳,闫非,赵亚男,陈伟杰,罗春材,张兴华,李涛..心脏磁共振成像对急性ST段抬高型心肌梗死后左心室不良重构的预测价值[J].南方医科大学学报,2024,44(3):553-562,10.基金项目
解放军总医院新技术新业务资助课题(20230116) （20230116）
