ST 段抬高型心肌梗死患者心脏 MRI 左心房应变的长期预后价值。
Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction.
机构信息
From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.).
出版信息
Radiology. 2020 Aug;296(2):299-309. doi: 10.1148/radiol.2020200176. Epub 2020 Jun 16.
Background Left atrial (LA) dysfunction is associated with morbidity and mortality. To the knowledge of the authors, the relationship of LA strain to long-term prognosis in participants with ST-segment elevation myocardial infarction (STEMI) is unknown. Purpose To evaluate LA strain as a long-term outcome predictor in STEMI in a prospective, multicenter cardiac MRI cohort. Materials and Methods Participants with STEMI who underwent primary percutaneous coronary intervention and cardiac MRI from 10 sites (EARLY-MYO-CMR registry, clinical trial number NCT03768453) were included. The parent study took place between August 2013 and December 2018. LA longitudinal strain and strain rate parameters were derived from cine cardiac MRI by using an in-house semiautomated method. Major adverse cardiac events (MACEs) were defined as cardiovascular death, myocardial reinfarction, hospitalization for heart failure, and stroke. The association between LA performance and MACE was evaluated by using time-dependent receiver operating characteristic analysis, Kaplan-Meier analysis, and multivariable Cox regression analysis. Results A total of 321 participants (median age, 59 years; age range, 27-75 years; 90% men) were included in this study. During median follow-up of 3.7 years, MACE occurred in 76 participants (23.7%). Participants with impaired reservoir (≤22%) and conduit strain (≤10%) had a higher risk of MACE than those with reservoir strain greater than 22% and conduit strain greater than 10% ( < .001). Reservoir strain (hazard ratio, 0.84; 95% confidence interval: 0.77, 0.91; < .001) and conduit strain (hazard ratio, 0.81; 95% confidence interval: 0.73, 0.89; < .001) were independent predictors for MACE after adjustment for known risk factors. Finally, LA reservoir and conduit strains provided incremental prognostic value over traditional outcome predictors (Uno statistic comparing models, 0.75 vs 0.68; = .04). Conclusion Assessment of left atrial strain, as a measure of left atrial function, provided incremental prognostic information to established predictors in ST-segment elevation myocardial infarction. © RSNA, 2020 See also the editorial by Kawel-Boehm and Bremerich in this issue.
背景
左心房（LA）功能障碍与发病率和死亡率有关。据作者所知，LA 应变与 ST 段抬高型心肌梗死（STEMI）患者的长期预后的关系尚不清楚。目的：在一项前瞻性、多中心心脏 MRI 队列中评估 STEMI 患者的 LA 应变作为长期预后预测因子。材料与方法：纳入了来自 10 个地点（EARLY-MYO-CMR 注册研究，临床试验编号 NCT03768453）的接受经皮冠状动脉介入治疗和心脏 MRI 的 STEMI 患者。主要研究于 2013 年 8 月至 2018 年 12 月进行。使用内部半自动方法从心脏电影 MRI 中得出 LA 纵向应变和应变率参数。主要不良心脏事件（MACE）定义为心血管死亡、心肌再梗死、心力衰竭住院和中风。通过时间依赖性接受者操作特征分析、Kaplan-Meier 分析和多变量 Cox 回归分析评估 LA 功能与 MACE 之间的关系。结果：共纳入 321 名参与者（中位年龄 59 岁；年龄范围 27-75 岁；90%为男性）。在中位随访 3.7 年期间，76 名参与者发生 MACE（23.7%）。与储备应变（＞22%）和传导应变（＞10%）异常的参与者相比，储备应变（＞22%）和传导应变（＞10%）异常的参与者发生 MACE 的风险更高（＜0.001）。储备应变（危险比，0.84；95%置信区间：0.77，0.91；＜0.001）和传导应变（危险比，0.81；95%置信区间：0.73，0.89；＜0.001）是调整已知危险因素后发生 MACE 的独立预测因子。最后，LA 储备和传导应变提供了比传统预后预测因子（Uno 统计比较模型，0.75 比 0.68；=0.04）更具增量预后价值。结论：作为左心房功能的衡量标准，LA 应变的评估为 ST 段抬高型心肌梗死的既定预测因子提供了增量预后信息。
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