Reindl Martin, Tiller Christina, Holzknecht Magdalena, Lechner Ivan, Eisner Dorothea, Riepl Laura, Pamminger Mathias, Henninger Benjamin, Mayr Agnes, Schwaiger Johannes P, Klug Gert, Bauer Axel, Metzler Bernhard, Reinstadler Sebastian J
University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Clin Res Cardiol. 2021 Jan;110(1):61-71. doi: 10.1007/s00392-020-01649-2. Epub 2020 Apr 15.
The role of left ventricular (LV) myocardial strain by cardiac magnetic resonance feature tracking (CMR-FT) for the prediction of adverse remodeling following ST-elevation myocardial infarction (STEMI), as well as its prognostic validity compared to LV ejection fraction (LVEF) and CMR infarct severity parameters, is unclear. This study aimed to evaluate the independent and incremental value of LV strain by CMR-FT for the prediction of adverse LV remodeling post-STEMI.
STEMI patients treated with primary percutaneous coronary intervention were enrolled in this prospective observational study. CMR core laboratory analysis was performed to assess LVEF, infarct pathology and LV myocardial strain. The primary endpoint was adverse remodeling, defined as ≥ 20% increase in LV end-diastolic volume from baseline to 4 months.
From the 232 patients included, 38 (16.4%) reached the primary endpoint. Global longitudinal strain (GLS), global radial strain, and global circumferential strain were all predictive of adverse remodeling (p < 0.01 for all), but only GLS was an independent predictor of adverse remodeling (odds ratio: 1.36[1.03-1.78]; p = 0.028) after adjustment for strain parameters, LVEF and CMR markers of infarct severity. A GLS > - 14% was associated with a fourfold increase in the risk for LV remodeling (odds ratio: 4.16[1.56-11.13]; p = 0.005). Addition of GLS to a baseline model comprising LVEF, infarct size and microvascular obstruction resulted in net reclassification improvement of 0.26 ([0.13-0.38]; p < 0.001) and integrated discrimination improvement of 0.02 ([0.01-0.03]; p = 0.006).
In STEMI survivors, determination of GLS using CMR-FT provides important prognostic information for the development of adverse remodeling that is incremental to LVEF and CMR markers of infarct severity.
NCT04113356.
心脏磁共振特征追踪（CMR-FT）测量的左心室（LV）心肌应变在预测ST段抬高型心肌梗死（STEMI）后不良重塑中的作用，以及与左心室射血分数（LVEF）和CMR梗死严重程度参数相比其预后有效性尚不清楚。本研究旨在评估CMR-FT测量的LV应变在预测STEMI后不良LV重塑中的独立和增量价值。
本前瞻性观察性研究纳入接受直接经皮冠状动脉介入治疗的STEMI患者。进行CMR核心实验室分析以评估LVEF、梗死病理和LV心肌应变。主要终点为不良重塑，定义为LV舒张末期容积从基线到4个月增加≥20%。
在纳入的232例患者中，38例（16.4%）达到主要终点。整体纵向应变（GLS）、整体径向应变和整体周向应变均能预测不良重塑（所有p<0.01），但在调整应变参数、LVEF和CMR梗死严重程度标志物后，只有GLS是不良重塑的独立预测因子（比值比：1.36[1.03-1.78]；p=0.028）。GLS>-14%与LV重塑风险增加四倍相关（比值比：4.16[1.56-11.13]；p=0.005）。将GLS添加到包含LVEF、梗死面积和微血管阻塞的基线模型中，净重新分类改善为0.26（[0.13-0.38]；p<0.001），综合判别改善为0.02（[0.01-0.03]；p=0.006）。
在STEMI幸存者中，使用CMR-FT测定GLS可为不良重塑的发生提供重要的预后信息，这是LVEF和CMR梗死严重程度标志物之外的增量信息。
NCT04113356。
