上海交通大学学报（医学版）2025，Vol.45Issue(12)：1578-1588,11.DOI:10.3969/j.issn.1674-8115.2025.12.003
基于心脏磁共振评估左心室心肌应变损伤对STEMI急性期继发性三尖瓣反流的影响
Impact of left ventricular myocardial strain injury on secondary tricuspid regurgitation in acute STEMI assessed by cardiac magnetic resonance
摘要
Abstract
Objective·To evaluate the relevant risk factors and pathophysiological mechanisms of moderate-to-severe secondary tricuspid regurgitation(STR)in acute ST-segment elevation myocardial infarction(STEMI)patients using cardiac magnetic resonance(CMR)imaging.Methods·A total of 729 STEMI patients who underwent percutaneous coronary intervention(PCI)at Renji Hospital,Shanghai Jiao Tong University School of Medicine,from August 2013 to June 2023 were analyzed.All patients underwent both CMR and transthoracic echocardiography(TTE)examinations within 2‒7 d post-PCI.Patients were stratified into two groups based on TTE findings:significant STR(moderate-to-severe)and non-significant STR(mild or absent).Clinical characteristics,CMR parameters,and the incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.Univariate and multivariate Logistic regression analyses were performed to identify independent predictors of significant STR.Results·Of the 729 enrolled STEMI patients,53(7.3%)developed significant STR.Compared to the non-significant STR group(n=676),patients with significant STR were older,had a lower proportion of males,and had a lower prevalence of hyperlipidemia(all P<0.05).Survival analysis revealed a significantly higher cumulative incidence of MACCEs in the significant STR group than in the non-significant STR group(log-rank P<0.001).CMR analysis revealed that the significant STR group exhibited more pronounced left ventricular remodeling and myocardial strain impairment,characterized by an increased left ventricular end-systolic volume index(LVESVi)and reduced left ventricular ejection fraction(LVEF).Additionally,this group showed significantly decreased left ventricular global radial strain(LV-GRS),the absolute value of left ventricular global circumferential strain(LV-GCS),the absolute value of radial peak early diastolic strain rate(rPEDSR),and circumferential peak early diastolic strain rate(cPEDSR)(all P<0.05).Multivariate Logistic regression analysis identified LVESVi(OR=1.030,95%CI 1.011‒1.049,P=0.002),LVEF(OR=0.963,95%CI 0.940‒0.986,P=0.002),LV-GRS(OR=0.953,95%CI 0.913‒0.994,P=0.026),and LV-GCS(OR=1.091,95%CI 1.011‒1.178,P=0.025)as independent factors associated with significant STR,all of which demonstrated good discriminative performance(all AUC>0.83).Conclusion·STR occurring acutely in STEMI patients is significantly associated with adverse clinical outcomes.Left ventricular structural remodeling and dysfunction are the key pathophysiological basis for its development.CMR-derived parameters provide crucial evidence for early identification and risk stratification of significant STR.关键词
ST段抬高型心肌梗死/继发性三尖瓣反流/心脏磁共振/心肌应变Key words
ST-segment elevation myocardial infarction(STEMI)/secondary tricuspid regurgitation(STR)/cardiac magnetic resonance(CMR)/myocardial strain分类
医药卫生引用本文复制引用
李文丽,金力行,赵怡超,钟方元,石瑶,雷杰,卜军,葛恒..基于心脏磁共振评估左心室心肌应变损伤对STEMI急性期继发性三尖瓣反流的影响[J].上海交通大学学报（医学版）,2025,45(12):1578-1588,11.基金项目
国家自然科学基金(81770238) （81770238）
新疆维吾尔自治区自然科学基金(2022D01C16) （2022D01C16）
上海市卫生健康委员会学科带头人计划(2022XD018). National Natural Science Foundation of China(81770238) （2022XD018）
Natural Science Foundation of Xinjiang Uygur Autonomous Region(2022D01C16) （2022D01C16）
Discipline Leader Program of Shanghai Municipal Health Commission(2022XD018). （2022XD018）
