From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.).
Radiology. 2019 Feb;290(2):329-337. doi: 10.1148/radiol.2018181253. Epub 2018 Nov 20.
Purpose To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results A total of 259 participants (mean age, 58 years ± 11 [standard deviation]; 198 men [mean age, 58 years ± 11] and 61 women [mean age, 58 years ± 12]) underwent cardiac MRI 2.2 days ± 1.9 after STEMI. Average infarct size was 18% ± 13 of LV mass and circumferential strain was -13% ± 3 (DENSE method) and -24% ± 7 (feature- tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P < .01). Conclusion Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Kramer in this issue.
目的 利用心脏 MRI 测量的环形左心室（LV）应变来预测急性 ST 段抬高型心肌梗死（STEMI）后主要不良心脏事件（MACE）的预后价值。
材料与方法 2011 年 5 月 11 日至 2012 年 11 月 22 日期间，前瞻性纳入急性 STEMI 患者。在住院期间于 1.5 T 上进行心脏 MRI。使用位移编码刺激回波（DENSE）和电影心脏 MRI 的特征跟踪来评估环形 LV 应变。由不了解基线观察结果的心脏病专家独立评估出院后的 MACE。
结果 共纳入 259 名患者（平均年龄 58 岁±11[标准差]；198 名男性[平均年龄 58 岁±11]和 61 名女性[平均年龄 58 岁±12]），在 STEMI 后 2.2 天±1.9 进行心脏 MRI。平均梗死面积为 LV 质量的 18%±13，环形应变分别为-13%±3（DENSE 法）和-24%±7（特征跟踪法）。51%（259 名患者中有 131 名）存在微血管阻塞。中位随访 4 年期间，8%（259 名患者中有 21 名）发生 MACE。DENSE 的曲线下面积（AUC）与特征跟踪的 AUC 不同（AUC，0.76 比 0.62；P=0.03）。DENSE 的 AUC 与初始梗死面积（P=0.06）和微血管阻塞程度（P=0.08）相似。DENSE 衍生的应变比梗死面积对 MACE 的预测具有更大的预后价值（危险比，1.3；P<0.01）。
结论 在急性 ST 段抬高型心肌梗死患者中，环形应变具有独立的预后重要性。在知识共享署名 4.0 许可下发布本文件。本文提供在线补充材料。请参见本期杂志中 Kramer 的社论。
