University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.
German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany; University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany.
Int J Cardiol. 2020 Jan 15;299:31-36. doi: 10.1016/j.ijcard.2019.06.036. Epub 2019 Jun 16.
Sex-specific outcome data following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse cardiac events (MACE). Since mechanistic principles remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation.
In total, 795 ST-elevation MI patients underwent post-interventional CMR imaging. Feature-tracking (CMR-FT) was performed in a blinded core-laboratory. Left ventricular function was quantified using ejection fraction (LVEF) and global longitudinal/circumferential/radial strains (GLS/GCS/GRS). Left atrial function was assessed by reservoir (εs), conduit (εe) and booster-pump strains (εa). Tissue characterisation included infarct size, microvascular obstruction and area at risk. Primary endpoint was the occurrence of MACE within 1 year.
Female sex was associated with increased MACE (HR 1.96, 95% CI 1.13-3.42, p = 0.017) but not independently of baseline confounders (p = 0.526) with women being older, more often diabetic and hypertensive (p < 0.001) and of higher Killip-class (p = 0.010). Tissue characterisation was similar between sexes. Women showed impaired atrial (εs p = 0.011, εe p < 0.001) but increased systolic ventricular mechanics (GLS p = 0.001, LVEF p = 0.048). While atrial and ventricular function predicted MACE in men only LV GLS and GCS were associated with MACE in women irrespective of confounders (GLS p = 0.036, GCS p = 0.04).
In men ventricular systolic contractility is impaired and volume assessments precisely stratify elevated risks. In contrast, women experience reduced atrial but increased ventricular systolic strain. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE adding incremental value to sex-specific prognosis evaluation.
心肌梗死后（MI）的性别特异性结局数据尚无定论，一些证据表明女性与主要不良心脏事件（MACE）增加有关。由于机制原理仍然难以捉摸，我们旨在使用心血管磁共振（CMR）定量变形成像和组织特征来量化潜在表型。
共有 795 例 ST 段抬高型 MI 患者接受了介入后 CMR 成像。特征跟踪（CMR-FT）在一个盲目的核心实验室进行。左心室功能使用射血分数（LVEF）和整体纵向/周向/径向应变（GLS/GCS/GRS）进行量化。左心房功能通过储备（εs）、导管（εe）和助推泵应变（εa）进行评估。组织特征包括梗死面积、微血管阻塞和危险区面积。主要终点是 1 年内发生 MACE。
女性发生 MACE 的风险较高（HR 1.96，95%CI 1.13-3.42，p=0.017），但与基线混杂因素无关（p=0.526），女性年龄较大，更常患有糖尿病和高血压（p<0.001），Killip 分级较高（p=0.010）。两性之间的组织特征相似。女性的心房（εs p=0.011，εe p<0.001）功能受损，但收缩期心室力学增强（GLS p=0.001，LVEF p=0.048）。虽然心房和心室功能仅在男性中预测 MACE，但 LV GLS 和 GCS 在女性中与 MACE 相关，与混杂因素无关（GLS p=0.036，GCS p=0.04）。
在男性中，心室收缩收缩力受损，容量评估精确分层风险增加。相反，女性经历心房收缩应变降低但心室收缩应变增加。这可能反映了心室舒张衰竭伴收缩补偿，这与 MACE 独立相关，为性别特异性预后评估增加了附加价值。
