微血管阻塞程度可预测射血分数保留的急性心肌梗死患者的主要不良心血管事件。

Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction.

机构信息

Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy.

Department of Experimental Medicine, University of Rome "Sapienza", Rome, Italy.

出版信息

Eur Radiol. 2019 May;29(5):2369-2377. doi: 10.1007/s00330-018-5895-z. Epub 2018 Dec 14.

DOI:10.1007/s00330-018-5895-z

PMID:30552479

Abstract

OBJECTIVES

To investigate the prognostic role of early post-infarction cardiac magnetic resonance (CMR) on long-term risk stratification of ST segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF).

METHODS

Seventy-seven STEMI patients treated by primary percutaneous coronary intervention (PCI) and LVEF > 50% at CMR were included. The median time between STEMI and CMR was 5 days (IQR 2-8). LV volumes and function, area at risk (on T2 weighted images), infarcted myocardium (on late enhanced images), intramyocardial hemorrhage, and early and late microvascular obstruction (MVO) were detected and measured. CMR tissue determinants were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up.

RESULTS

During median follow-up of 4 years (range 3 to 5 years), eight (10%) patients experienced MACE, yielding an annualized event rate of 2.1%. All CMR tissue markers were not significantly different between MACE and no-MACE patients, except for the presence of late MVO (50% vs. 16%, respectively; p = 0.044) and its extent (2.30 ± 1.64 g vs. 0.18 ± 0.12 g, respectively; p = 0.000). From receiver-operating characteristic (ROC) curve (area under the curve 0.89; 95% confidence interval, 0.75-1.0; p = 0.000), late MVO extent > 0.385 g was a strong independent predictor of MACE at long-term follow-up (sensitivity = 87%, specificity = 90%; hazard ratio = 2.24; 95% confidence interval, 1.51-3.33; p = 0.000).

CONCLUSIONS

Late MVO extent after primary PCI on CMR seems to be a strong predictor of MACE at 5-year follow-up in patients with LVEF > 50%. Noticeably, late MVO extent > 0.385 g provided relevant prognostic insights leading to improved long-term risk stratification.

KEY POINTS

• Tissue markers provided by cardiac magnetic resonance aid in prognostic stratification after myocardial infarction • The occurrence of late microvascular obstruction after acute myocardial infarction increases risk of major adverse events at 5-year follow-up. • The greater microvascular obstruction extent on late gadolinium enhanced images is related to an increased risk of adverse events in patients with myocardial infarction and preserved left ventricular function.

摘要

目的

探讨心肌梗死后早期心脏磁共振（CMR）对左心室射血分数（LVEF）保留的 ST 段抬高型心肌梗死（STEMI）患者长期风险分层的预测价值。

方法

纳入 77 例接受直接经皮冠状动脉介入治疗（PCI）且 CMR 显示 LVEF>50%的 STEMI 患者。STEMI 与 CMR 之间的中位时间为 5 天（IQR 2-8）。检测和测量 LV 容积和功能、危险区（T2 加权图像上）、梗死心肌（晚期钆增强图像上）、心肌内出血以及早期和晚期微血管阻塞（MVO）。CMR 组织标志物与 5 年随访期间主要不良心血管事件（MACE）的发生率相关。

结果

中位随访 4 年（范围 3-5 年）期间，8 例（10%）患者发生 MACE，年发生率为 2.1%。MACE 与无 MACE 患者的所有 CMR 组织标志物均无显著差异，除晚期 MVO 的存在（分别为 50%和 16%；p=0.044）及其程度（分别为 2.30±1.64 g 和 0.18±0.12 g；p=0.000）外。从受试者工作特征（ROC）曲线（曲线下面积 0.89；95%置信区间，0.75-1.0；p=0.000）来看，晚期 MVO 程度>0.385 g 是长期随访中 MACE 的强独立预测因子（灵敏度 87%，特异性 90%；危险比 2.24；95%置信区间，1.51-3.33；p=0.000）。