Zhang Min, Lu Yuan, Li Zhi, Shao Yameng, Chen Lei, Yang Yu, Xi Jianning, Chen Minglong, Jiang Tingbo
Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Front Cardiovasc Med. 2022 Feb 21;8:804020. doi: 10.3389/fcvm.2021.804020. eCollection 2021.
Cardiac magnetic resonance imaging (CMR) can be used for a one-step evaluation of myocardial function and pathological features after acute ST-elevation myocardial infarction (STEMI). We aimed to evaluate the value of fast microvascular occlusion (MVO) identification from contrast-enhanced steady-state free precession (CE-SSFP) combined with myocardial strain in predicting major cardiovascular adverse events (MACEs) in primary percutaneous coronary intervention (pPCI) patients with STEMI.
In total, 237 patients with STEMI who received pPCI and completed CMR scans within the following week were enrolled, MVO identification and the myocardial strain analysis were performed in CE-SSFP images without an additional method. The primary endpoint was the presence of MACE, which is defined as a composite of death, reinfarction, and congestive heart failure (HF).
After 13 months of follow-up [interquartile range (IQR): 11-24], 30 patients (14%) developed MACE; the MVO (hazard ratio (HR) was 3.10; 95% CI: 1.14-8.99, = 0.028), and the infarct size (IS) (HR: 1.03; 95% CI: 1.0-1.06, = 0.042) and global longitudinal strain (GLS) (HR: 1.08; 95% CI: 1.01-1.17, = 0.029) were finally associated with MACE. Receiver operating characteristic (ROC) analyses show that the area under the curve (AUC) of GLS was large (0.73 [95% CI, 0.63-0.82], = 0.001), and the best cut-off was -11.8%, with 76.7% sensitivity and 58.9% specificity, which are greater than those of IS (0.70, 95% CI, 0.60-0.81, < 0.001) and MVO (0.68, 95% CI, 0.58-0.78, < 0.001). However, combining MVO and GLS resulted in a much greater finding (AUC = 0.775, 95% CI: 0.727-0.824, < 0.001) and better sensitivity and specificity (83.3%, 66.5%).
Microvascular occlusion identification from contrast-enhanced cine combined with myocardial strain could be a quick and reliable option for patients with STEMI who underwent pPCI; it correlates well with the prognosis of patients with STEMI in terms of MACE.
心脏磁共振成像（CMR）可用于对急性ST段抬高型心肌梗死（STEMI）后的心肌功能和病理特征进行一步评估。我们旨在评估从对比增强稳态自由进动（CE-SSFP）结合心肌应变快速识别微血管阻塞（MVO）在预测接受直接经皮冠状动脉介入治疗（pPCI）的STEMI患者主要心血管不良事件（MACE）中的价值。
总共纳入了237例接受pPCI并在接下来一周内完成CMR扫描的STEMI患者，在CE-SSFP图像中进行MVO识别和心肌应变分析，无需额外方法。主要终点是MACE的发生，其定义为死亡、再梗死和充血性心力衰竭（HF）的复合事件。
随访13个月[四分位间距（IQR）：11 - 24]后，30例患者（14%）发生MACE；MVO（风险比（HR）为3.10；95%置信区间：1.14 - 8.99，P = 0.028）、梗死面积（IS）（HR：1.03；95%置信区间：1.0 - 1.06，P = 0.042）和整体纵向应变（GLS）（HR：1.08；95%置信区间：1.01 - 1.17，P = 0.029）最终与MACE相关。受试者工作特征（ROC）分析表明，GLS的曲线下面积（AUC）较大（0.73 [95%置信区间，0.63 - 0.82]，P = 0.001），最佳截断值为 - 11.8%，敏感性为76.7%，特异性为58.9%，大于IS（0.70，95%置信区间，0.60 - 0.81，P < 0.001）和MVO（0.68，95%置信区间，0.58 - 0.78，P < 0.001）。然而，将MVO和GLS结合起来有更大的发现（AUC = 0.775，95%置信区间：0.727 - 0.824，P < 0.001）以及更好的敏感性和特异性（83.3%，66.5%）。
从对比增强电影成像结合心肌应变识别微血管阻塞对于接受pPCI的STEMI患者可能是一种快速且可靠的方法；就MACE而言，它与STEMI患者的预后相关性良好。
