早期心脏磁共振成像功能和几何指标对前壁 ST 段抬高型心肌梗死患者不良左心室重构的预测价值：来自 CIRCUS 研究的报告。
Predictive value of early cardiac magnetic resonance imaging functional and geometric indexes for adverse left ventricular remodelling in patients with anterior ST-segment elevation myocardial infarction: A report from the CIRCUS study.
机构信息
Inserm, UMRS 942, Department of Cardiology, Lariboisière Hospital, Paris University, AP-HP, 75010 Paris, France; Division of Cardiology, Johns-Hopkins University, 21287-0409 Baltimore, MD, USA.
Inserm 1407, Clinical Investigation Centre and Heart Failure Department, Cardiovascular Hospital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69677 Bron, France.
出版信息
Arch Cardiovasc Dis. 2020 Nov;113(11):710-720. doi: 10.1016/j.acvd.2020.05.024. Epub 2020 Nov 5.
BACKGROUND
Postinfarction adverse left ventricular (LV) remodelling is strongly associated with heart failure events. Conicity index, sphericity index and LV global functional index (LVGFI) are new LV remodelling indexes assessed by cardiac magnetic resonance (CMR).
AIM
To assess the predictive value of the new indexes for 1-year adverse LV remodelling in patients with anterior ST-segment elevated myocardial infarction (STEMI).
METHODS
CMR studies were performed in 129 patients with anterior STEMI (58±12 years; 78% men) from the randomized CIRCUS trial (CMR substudy) treated with primary percutaneous coronary intervention and followed for the occurrence of major adverse cardiovascular events (MACE) (death or hospitalization for heart failure). Conicity index, sphericity index, LVGFI, infarct size and microvascular obstruction (MVO) were assessed by CMR performed 5±4 days after coronary reperfusion. Adverse LV remodelling was defined as an increase in LV end-diastolic volume of ≥15% by transthoracic echocardiography at 1 year.
RESULTS
Adverse LV remodelling occurred in 27% of patients at 1 year. Infarct size and MVO were significantly predictive of adverse LV remodelling: odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05 (P<0.001) and OR 1.12, 95% CI 1.05-1.22 (P<0.001), respectively. Among the newly tested indexes, only LVGFI was significantly predictive of adverse LV remodelling (OR 1.10, 95% CI 1.03-1.16; P=0.001). In multivariable analysis, infarct size remained an independent predictor of adverse LV remodelling at 1 year (OR 1.05, 95% CI 1.02-1.08; P<0.001). LVGFI and infarct size were associated with occurrence of MACE: OR 1.21, 95% CI 1.08-1.37 (P<0.001) and OR 1.02, 95% CI 1.00-1.04 (P=0.018), respectively. Conicity and sphericity indexes were not associated with MACE.
CONCLUSIONS
LVGFI was associated with adverse LV remodelling and MACE 1 year after anterior STEMI.
背景
心肌梗死后的左心室（LV）不良重构与心力衰竭事件密切相关。心脏磁共振（CMR）评估的新的LV 重构指数包括心尖指数、球形指数和 LV 整体功能指数（LVGFI）。
目的
评估新指数在前壁 ST 段抬高型心肌梗死（STEMI）患者 1 年内不良 LV 重构的预测价值。
方法
对接受直接经皮冠状动脉介入治疗的前壁 STEMI 患者（129 例，年龄 58±12 岁，78%为男性）进行 CMR 研究（CMR 子研究），这些患者来自 CIRCUS 试验，随访 1 年主要不良心血管事件（MACE）（死亡或因心力衰竭住院）的发生情况。CMR 评估心尖指数、球形指数、LVGFI、梗死面积和微血管阻塞（MVO），在再灌注后 5±4 天进行。通过 1 年时的经胸超声心动图评估 LV 舒张末期容积增加≥15%来定义不良 LV 重构。
结果
1 年后有 27%的患者发生不良 LV 重构。梗死面积和 MVO 对不良 LV 重构有显著预测作用：比值比[OR] 1.03，95%置信区间[CI] 1.01-1.05（P<0.001）和 OR 1.12，95% CI 1.05-1.22（P<0.001）。在新测试的指标中，只有 LVGFI 对不良 LV 重构有显著预测作用（OR 1.10，95% CI 1.03-1.16；P=0.001）。多变量分析显示，梗死面积仍是 1 年后不良 LV 重构的独立预测因素（OR 1.05，95% CI 1.02-1.08；P<0.001）。LVGFI 和梗死面积与 MACE 的发生相关：OR 1.21，95% CI 1.08-1.37（P<0.001）和 OR 1.02，95% CI 1.00-1.04（P=0.018）。心尖指数和球形指数与 MACE 无关。
结论
LVGFI 与前壁 STEMI 后 1 年的不良 LV 重构和 MACE 相关。
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