Hospital Clínic Universitari de València-INCLIVA, Department of Cardiology, Spain.
Circ Cardiovasc Imaging. 2013 Sep;6(5):755-61. doi: 10.1161/CIRCIMAGING.113.000702. Epub 2013 Aug 7.
Infarct size (IS) determined by cardiac magnetic resonance (CMR) has proven an additional value, on top of left ventricular ejection fraction (LVEF), in prediction of adverse arrhythmic cardiac events (AACEs) in chronic ischemic heart disease. Its value soon after an acute ST-segment-elevation myocardial infarction remains unknown. Our aim was to determine whether early CMR can improve AACE risk prediction after acute ST-segment-elevation myocardial infarction.
Patients admitted for a first noncomplicated ST-segment-elevation myocardial infarction were prospectively followed up. A total of 440 patients were included. All of them underwent CMR 1 week after admission. CMR-derived LVEF and IS (grams per meter squared) were quantified. AACEs included postdischarge sudden death, sustained ventricular tachycardia, and ventricular fibrillation either documented on ECG or recorded via an implantable cardioverter-defibrillator. Within a median follow-up of 2 years, 11 AACEs (2.5%) were detected: 5 sudden deaths (1.1%) and 6 spontaneous ventricular tachycardia/ventricular fibrillation. In the whole group, AACEs associated with more depressed LVEF (adjusted hazard ratio [95% confidence interval], 0.90 [0.83-0.97]; P<0.01) and larger IS (adjusted hazard ratio [95% confidence interval], 1.06 [1.01-1.12]; P=0.01). According to the corresponding area under the receiver operating characteristic curve, LVEF ≤36% and IS ≥23.5 g/m(2) best predicted AACEs. The vast majority of AACEs (10/11) occurred in patients with simultaneous depressed LVEF ≤36% and IS ≥23.5 g/m(2) (n=39).
In the era of reperfusion therapies, occurrence of AACEs in patients with an in-hospital noncomplicated first ST-segment-elevation myocardial infarction is low. In this setting, assessment of an early CMR-derived IS could be useful for further optimization of AACE risk prediction.
心脏磁共振（CMR）检测的梗死面积（IS）除了左心室射血分数（LVEF）外，还可预测慢性缺血性心脏病不良心律失常心脏事件（AACE），其价值在急性 ST 段抬高型心肌梗死（STEMI）后不久仍不清楚。我们的目的是确定急性 STEMI 后早期 CMR 是否可以改善 AACE 风险预测。
前瞻性随访因首次非复杂 STEMI 入院的患者。共纳入 440 例患者，所有患者均于入院后 1 周行 CMR。量化 CMR 衍生的 LVEF 和 IS（克/米）。AACE 包括出院后猝死、持续性室性心动过速和室颤，通过心电图或植入式心脏复律除颤器记录。中位随访 2 年内，发生 11 例 AACE（2.5%）：5 例猝死（1.1%）和 6 例自发性室性心动过速/室颤。在整个组中，AACE 与更低的 LVEF 相关（调整后的危险比[95%置信区间]，0.90[0.83-0.97]；P<0.01）和更大的 IS（调整后的危险比[95%置信区间]，1.06[1.01-1.12]；P=0.01）。根据相应的接受者操作特征曲线下面积，LVEF≤36%和 IS≥23.5 g/m（2）最佳预测 AACE。大多数 AACE（10/11）发生在同时存在 LVEF≤36%和 IS≥23.5 g/m（2）的患者中（n=39）。
在再灌注治疗时代，住院期间首次非复杂 STEMI 患者发生 AACE 的概率较低。在此背景下，评估早期 CMR 衍生的 IS 可能有助于进一步优化 AACE 风险预测。
