CNR, Institute of Clinical Physiology, G. Monasterio Foundation, Via Moruzzi, 1, 56124, Pisa, Italy.
Eur Heart J. 2013 Jan;34(2):104-11. doi: 10.1093/eurheartj/ehs037. Epub 2012 Feb 24.
We sought to investigate whether combining left ventricular (LV) volumes, regional wall motion abnormalities, and scar tissue extent obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous myocardial infarction (MI).
In 231 consecutive patients (age 64 ± 11 years, males 89%) with previous MI, we quantified LV volumes and regional wall motion abnormalities by cine CMR, and measured the extent of the infarction scar by late gadolinium enhancement (LGE). During follow-up (median, 3.2 years) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 19 patients. After adjustment for age, an extent of LGE >12.7%, an LV end-diastolic volume >105 mL/m(2), and a wall motion score index >1.7 were independent associated with adverse cardiac events at multivariate analysis (P < 0.05, P < 0.001, and P < 0.01, respectively). The patients with none of these factors, and those with one or two factors, showed a lower risk of cardiac events [hazard ratio (HR) = 0.112, P < 0.01 and HR = 0.261, P < 0.05] than those with three factors. The cumulative event-rate estimated at 4 years was 29.6% in patients with all three factors, 7.7% in those with one or two factors, and 3.5% in patients with none of these factors.
A multiparametric CMR approach, which includes the measure of scar tissue extent, LV end-diastolic volume and regional wall motion abnormalities, improves risk stratification of patients with previous MI.
我们旨在研究通过心脏磁共振（CMR）获得的左心室（LV）容积、局部室壁运动异常和瘢痕组织范围是否能改善既往心肌梗死（MI）患者的风险分层。
在 231 例连续的既往 MI 患者（年龄 64 ± 11 岁，男性 89%）中，我们通过电影 CMR 量化 LV 容积和局部室壁运动异常，并通过晚期钆增强（LGE）测量梗死瘢痕的范围。在随访期间（中位数为 3.2 年），19 例患者发生心脏事件（心脏死亡或适当的心脏内除颤器电击）。在校正年龄后，LGE 范围 >12.7%、LV 舒张末期容积 >105 mL/m2 和壁运动评分指数 >1.7 在多变量分析中与不良心脏事件独立相关（P < 0.05、P < 0.001 和 P < 0.01，分别）。没有这些因素的患者，以及有一个或两个因素的患者，发生心脏事件的风险较低[风险比（HR）=0.112，P < 0.01 和 HR = 0.261，P < 0.05]，而有三个因素的患者风险较高。在 4 年时，有三个因素的患者累积事件发生率为 29.6%，有一个或两个因素的患者为 7.7%，没有这些因素的患者为 3.5%。
一种多参数 CMR 方法，包括测量瘢痕组织范围、LV 舒张末期容积和局部室壁运动异常，可改善既往 MI 患者的风险分层。
