南方医科大学学报2025，Vol.45Issue(4)：669-683,15.DOI:10.12122/j.issn.1673-4254.2025.04.01
急性ST段抬高型心肌梗死经皮冠状动脉介入术后左心室不良重构的新型风险预测模型:基于心脏磁共振的多中心前瞻性研究
A cardiac magnetic resonance-based risk prediction model for left ventricular adverse remodeling following percutaneous coronary intervention for acute ST-segment elevation myocardial infarction:a multi-center prospective study
摘要
Abstract
Objective To develop a risk prediction model for left ventricular adverse remodeling(LVAR)based on cardiac magnetic resonance(CMR)parameters in patients undergoing percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 329 acute STEMI patients undergoing primary PCI at 8 medical centers from January,2018 to December,2021 were prospectively enrolled.The parameters of CMR,performed at 7±2 days and 6 months post-PCI,were analyzed using CVI42 software.LVAR was defined as an increase>20%in left ventricular end-diastolic volume or>15%in left ventricular end-systolic volume at 6 months compared to baseline.The patients were randomized into training(n=230)and validation(n=99)sets in a 7∶3 ratio.In the training set,potential predictors were selected using LASSO regression,followed by univariate and multivariate logistic regression to construct a nomogram.Model performance was evaluated using receiver-operating characteristic(ROC)curves,area under the curve(AUC),calibration curves,and decision curve analysis.Results LVAR occurred in 100 patients(30.40%),who had a higher incidence of major adverse cardiovascular events than those without LVAR(58.00%vs 16.16%,P<0.001).Left ventricular global longitudinal strain(LVGLS;OR=0.76,95%CI:0.61-0.95,P=0.015)and left atrial active strain(LAAS;OR=0.78,95%CI:0.67-0.92,P=0.003)were protective factors for LVAR,while infarct size(IS;OR=1.05,95%CI:1.01-1.10,P=0.017)and microvascular obstruction(MVO;OR=1.26,95%CI:1.01-1.59,P=0.048)were risk factors for LVAR.The nomogram had an AUC of 0.90(95%CI:0.86-0.94)in the training set and an AUC of 0.88(95%CI:0.81-0.94)in the validation set.Conclusion LVGLS,LAAS,IS,and MVO are independent predictors of LVAR in STEMI patients following PCI.The constructed nomogram has a strong predictive ability to provide assistance for management and early intervention of LVAR.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/列线图Key words
left ventricular adverse remodeling/acute ST-elevation myocardial infarction/cardiac magnetic resonance/nomogram引用本文复制引用
马振岩,阿鑫,赵蕾,张洪博,刘科,赵依晴,钱赓..急性ST段抬高型心肌梗死经皮冠状动脉介入术后左心室不良重构的新型风险预测模型:基于心脏磁共振的多中心前瞻性研究[J].南方医科大学学报,2025,45(4):669-683,15.基金项目
中华心血管病发展专项基金心脏健康科研基金项目(Z-2019-42-1908-2),首都卫生发展科研专项项目(SF2020-2-5012) （Z-2019-42-1908-2）
