Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universidad de Valencia, Blasco Ibanez 17, 46010, Valencia, Spain,
Int J Cardiovasc Imaging. 2013 Oct;29(7):1499-509. doi: 10.1007/s10554-013-0239-1. Epub 2013 Jun 4.
Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4-9] vs. 3 [1-5], p < .0001) and a larger SS at 6 months (5 [2-6] vs. 3 [1-5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14-1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.
在 ST 段抬高型心肌梗死（MI）后 1 周，梗死面积（IS）会逐渐缩小。IS 再缩小和 6 个月时瘢痕面积（SS）的预后增值作用尚不清楚。我们比较了 MI 后 1 周和 6 个月的 CMR 检测的 IS 和 SS，以预测晚期主要不良心脏事件（MACE）。250 例患者在 MI 后 1 周和 6 个月行 CMR 检查。IS 和 SS 是通过透壁性晚期钆增强（＞50%的壁厚度，ETLE）来确定。在 163 周期间，23 例晚期 MACE（心脏死亡、MI 或 6 个月 CMR 后心力衰竭再入院）发生。发生晚期 MACE 的患者在 1 周时的 IS 更大（6[4-9] 比 3[1-5]，p<0.0001），6 个月时的 SS 更大（5[2-6] 比 3[1-5]，p=0.005）。IS＞中位数患者在 1 周时的晚期 MACE 发生率更高（14%比 4%，p=0.007），在 SS＞中位数患者在 6 个月时的晚期 MACE 发生率更高（12%比 5%，p=0.053）。1 周和 6 个月 CMR 预测晚期 MACE 的 C 统计量相当（0.720 比 0.746，p=0.1）。仅 1 周时的 ETLE（HR 1.31，95%CI[1.14-1.52]，p<0.0001，每节段）独立预测晚期 MACE。6 个月时的 CMR 检测 SS 并不能提供 MI 后 1 周时 IS 以外的预后价值。晚期 MACE 的最强预测因素是 1 周时的 ETLE。
