University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
JACC Cardiovasc Imaging. 2018 Oct;11(10):1433-1444. doi: 10.1016/j.jcmg.2017.11.034. Epub 2018 Feb 14.
The aims of the study were to assess the prognostic significance of cardiac magnetic resonance myocardial feature tracking (CMR-FT) in a large multicenter study and to evaluate the most potent CMR-FT predictor of hard clinical events following myocardial infarction (MI).
CMR-FT is a new method that allows accurate assessment of global and regional circumferential, radial, and longitudinal myocardial strain. The prognostic value of CMR-FT in patients with reperfused MI is unknown.
The study included 1,235 MI patients (n = 795 with ST-segment elevation MI and 440 with non-ST-elevation MI) at 15 centers. All patients were reperfused by primary percutaneous coronary intervention. Central core laboratory-masked analyses were performed to determine left ventricular (LV) circumferential, radial, and longitudinal strain. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events within 12 months after infarction.
Patients with cardiovascular events had significantly impaired CMR-FT strain values (p < 0.001 for all). Global longitudinal strain was identified as the strongest CMR-FT parameter of future cardiovascular events and emerged as an independent predictor of poor prognosis following MI even after adjustment for established prognostic markers. Global longitudinal strain provided an incremental prognostic value for all-cause mortality above LV ejection fraction (c-index increase from 0.65 to 0.73; p = 0.04) and infarct size (c-index increase from 0.60 to 0.78; p = 0.002).
CMR-FT is a superior measure of LV function and performance early after reperfused MI with incremental prognostic value for mortality over and above LV ejection fraction and infarct size. (Abciximab i.v. Versus i.c. in ST-segment elevation Myocardial Infarction [AIDA STEMI]; NCT00712101; Thrombus Aspiration in ThrOmbus Containing culpRIT Lesions in Non-ST-Elevation Myocardial Infarction [TATORT-NSTEMI]; NCT01612312).
本研究旨在评估心脏磁共振心肌特征追踪（CMR-FT）在一项大型多中心研究中的预后意义，并评估心肌梗死后发生硬临床事件的最有力 CMR-FT 预测因子。
CMR-FT 是一种新方法，可准确评估整体和局部圆周、径向和纵向心肌应变。再灌注性心肌梗死后患者 CMR-FT 的预后价值尚不清楚。
本研究纳入了 15 个中心的 1235 例心肌梗死患者（n=795 例 ST 段抬高型心肌梗死和 440 例非 ST 段抬高型心肌梗死）。所有患者均通过经皮冠状动脉介入术进行再灌注。采用中心核心实验室屏蔽分析来确定左心室（LV）圆周、径向和纵向应变。研究的主要临床终点是梗塞后 12 个月内发生主要不良心脏事件。
心血管事件患者的 CMR-FT 应变值明显受损（p<0.001 均有）。整体纵向应变是未来心血管事件最强的 CMR-FT 参数，即使在调整了既定预后标志物后，也被认为是 MI 后预后不良的独立预测因子。整体纵向应变在全因死亡率方面提供了优于左心室射血分数（指数增加 0.04；p=0.04）和梗塞面积（指数增加 0.08；p=0.002）的增量预后价值。
CMR-FT 是再灌注性 MI 后早期评估左心室功能和性能的优越指标，其在死亡率方面的预后价值优于左心室射血分数和梗塞面积。（静脉内与冠状动脉内注射阿昔单抗治疗 ST 段抬高型心肌梗死 [AIDA STEMI]；NCT00712101；血栓抽吸治疗非 ST 段抬高型心肌梗死伴血栓病变 [TATORT-NSTEMI]；NCT01612312）。
