首次 ST 段抬高型心肌梗死心脏磁共振成像后即刻预测逆向重构：一项大型前瞻性注册研究结果。
Prediction of Reverse Remodeling at Cardiac MR Imaging Soon after First ST-Segment-Elevation Myocardial Infarction: Results of a Large Prospective Registry.
机构信息
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
出版信息
Radiology. 2016 Jan;278(1):54-63. doi: 10.1148/radiol.2015142674. Epub 2015 Sep 4.
PURPOSE
To assess predictors of reverse remodeling by using cardiac magnetic resonance (MR) imaging soon after ST-segment-elevation myocardial infarction (STEMI).
MATERIALS AND METHODS
Written informed consent was obtained from all patients, and the study protocol was approved by the institutional committee on human research, ensuring that it conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Five hundred seven patients (mean age, 58 years; age range, 24-89 years) with a first STEMI were prospectively studied. Infarct size and microvascular obstruction (MVO) were quantified at late gadolinium-enhanced imaging. Reverse remodeling was defined as a decrease in left ventricular (LV) end-systolic volume index (LVESVI) of more than 10% from 1 week to 6 months after STEMI. For statistical analysis, a simple (from a clinical perspective) multiple regression model preanalyzing infarct size and MVO were applied via univariate receiver operating characteristic techniques.
RESULTS
Patients with reverse remodeling (n = 211, 42%) had a lesser extent (percentage of LV mass) of 1-week infarct size (mean ± standard deviation: 18% ± 13 vs 23% ± 14) and MVO (median, 0% vs 0%; interquartile range, 0%-1% vs 0%-4%) than those without reverse remodeling (n = 296, 58%) (P < .001 in pairwise comparisons). The independent predictors of reverse remodeling were infarct size (odds ratio, 0.98; 95% confidence interval [CI]: 0.97, 0.99; P = .04) and MVO (odds ratio, 0.92; 95% CI: 0.86, 0.99; P = .03). Once infarct size and MVO were dichotomized by using univariate receiver operating characteristic techniques, the only independent predictor of reverse remodeling was the presence of simultaneous nonextensive infarct-size MVO (infarct size < 30% of LV mass and MVO < 2.5% of LV mass) (odds ratio, 3.2; 95% CI: 1.8, 5.7; P < .001).
CONCLUSION
Assessment of infarct size and MVO with cardiac MR imaging soon after STEMI enables one to make a decision in the prediction of reverse remodeling.
目的
使用心脏磁共振（MR）成像评估 ST 段抬高型心肌梗死（STEMI）后即刻的逆重构预测因素。
材料与方法
所有患者均签署了书面知情同意书，研究方案经机构人体研究委员会批准，确保符合 1975 年《赫尔辛基宣言》的伦理准则。前瞻性研究了 507 例首次发生 STEMI 的患者（平均年龄 58 岁；年龄范围 24-89 岁）。在晚期钆增强成像时定量评估梗死面积和微血管阻塞（MVO）。逆重构定义为 STEMI 后 1 周至 6 个月时左心室（LV）收缩末期容积指数（LVESVI）下降超过 10%。为了进行统计分析，通过单变量接受者操作特征技术，对梗死面积和 MVO 进行了简单（从临床角度来看）的多元回归模型分析。
结果
发生逆重构的患者（n=211，42%）的 1 周梗死面积（平均值±标准差：18%±13%比 23%±14%）和 MVO（中位数，0%比 0%；四分位距，0%-1%比 0%-4%）较小（P<0.001，两两比较）。逆重构的独立预测因素是梗死面积（比值比，0.98；95%置信区间[CI]：0.97，0.99；P=0.04）和 MVO（比值比，0.92；95%CI：0.86，0.99；P=0.03）。通过单变量接受者操作特征技术对梗死面积和 MVO 进行二分法后，唯一的独立预测因素是同时存在非广泛的梗死面积-MVO（梗死面积<LV 质量的 30%和 MVO<LV 质量的 2.5%）（比值比，3.2；95%CI：1.8，5.7；P<0.001）。
结论
STEMI 后即刻使用心脏 MR 成像评估梗死面积和 MVO 可用于预测逆重构。
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