Marcos-Garcés Víctor, Merenciano-González Héctor, Gavara José, Gabaldón-Pérez Ana, López-Lereu María P, Monmeneu José V, Nuñez Julio, Pérez Nerea, Ríos-Navarro César, de Dios Elena, Chorro Francisco J, Valente Filipa, Lorenzatti Daniel, Domenech-Ximenos Blanca, Alonso Tello Albert, Maymí-Ballesteros Manel, Rello-Sabaté Pau, Morr Carlos Igor, Ortiz-Pérez Jose T, Rodríguez-Palomares Jose F, Bodí Vicente
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
INCLIVA Health Research Institute, Valencia, Spain.
J Magn Reson Imaging. 2023 Nov;58(5):1507-1518. doi: 10.1002/jmri.28632. Epub 2023 Feb 7.
Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF).
To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70 years) and nonelderly patients after STEMI.
Prospective.
Multicenter registry of 759 reperfused STEMI patients (23.3% elderly).
FIELD STRENGTH/SEQUENCE: 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences.
One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, ≥50%), mildly reduced (mr-LVEF, 41%-49%), or reduced (r-LVEF, ≤40%). Median follow-up was 5 [2.33-7.54] years.
Univariable (Student's t, Mann-Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P < 0.05 was considered statistically significant.
Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91-0.98]) and elderly patients (HR 0.94 [0.91-0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67-22.32]) and elderly patients (HR 7.55 [3.29-17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54-8.68]). Less transitions to higher LVEF states (n = 19, 30.2% vs. n = 98, 53%) and more transitions to AHF state (n = 34, 53.9% vs. n = 45, 24.3%) were observed in elderly than nonelderly patients.
MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group.
Stage 2.
ST段抬高型心肌梗死（STEMI）患者，尤其是老年患者，急性心力衰竭（AHF）再入院风险增加。
研究MRI测定的左心室射血分数（LVEF）对预测老年（>70岁）和非老年STEMI患者AHF的影响。
前瞻性研究。
759例再灌注STEMI患者的多中心登记研究（23.3%为老年患者）。
场强/序列：1.5-T。平衡稳态自由进动（电影成像）和分段反转恢复稳态自由进动（延迟钆增强）序列。
对MRI测定的1周LVEF（%）进行量化。579例患者记录了连续的MRI数据。根据MRI测定的LVEF将患者分为保留（p-LVEF，≥50%）、轻度降低（mr-LVEF，41%-49%）或降低（r-LVEF，≤40%）。中位随访时间为5[2.33-7.54]年。
单变量（Student's t检验、Mann-Whitney U检验、卡方检验和Fisher精确检验）和多变量（Cox比例风险回归）比较以及连续时间多状态马尔可夫模型，以分析LVEF类别之间以及向AHF的转变。计算95%置信区间（CI）的风险比（HR）。P<0.05被认为具有统计学意义。
在随访期间，79例（10.4%）患者发生AHF。MRI-LVEF是预测非老年患者（HR 0.94[0.91-0.98]）和老年患者（HR 0.94[0.91-0.97]）AHF最可靠的指标。老年患者在整个LVEF范围内AHF风险均增加。与p-LVEF相比，r-LVEF患者在非老年患者（HR 11.25[5.67-22.32]）和老年患者（HR 7.55[3.29-17.34]）中均存在额外风险。然而，mr-LVEF类别仅在老年患者中与AHF风险增加相关（HR 3.66[1.54-8.68]）。与非老年患者相比，老年患者向更高LVEF状态的转变较少（n=19，30.2%对n=98，53%），向AHF状态的转变较多（n=34，53.9%对n=45，24.3%）。
MRI测定的p-LVEF预后良好，r-LVEF可识别老年和非老年患者中AHF风险最高的个体。然而，老年组中mr-LVEF类别也存在额外风险。
2级。
2级。
