Department of Radiology, the First Medical center, PLA General Hospital, Beijing, China.
Department of Cardiology, The Six Medical Center, PLA General Hospital, Beijing, China.
Eur Radiol. 2023 Dec;33(12):8501-8512. doi: 10.1007/s00330-023-09907-3. Epub 2023 Jul 17.
To evaluate the changes in cardiac magnetic resonance (CMR) characteristics and investigate the predictors of reverse left ventricular remodeling (r-LVR) in ST-segment elevation myocardial infarction (STEMI) patients.
Eighty-six STEMI patients (median 56 years) were retrospectively studied. The patients were divided into r-LVR and without r-LVR groups. CMR analysis included LV volume, infarct characteristics, and global and regional myocardial function. The strain and displacement were assessed by CMR-feature tracking. The predictors of r-LVR were analyzed by the logistic regression method.
There were 37 patients in the r-LVR group and 49 patients in the without r-LVR group. At initial CMR, there was no difference in LV volume and global cardiac function between the two groups. However, the infarct zone radial and longitudinal displacements were higher in the r-LVR group (p < 0.05, respectively). At the second CMR, the r-LVR group showed higher LVEF, lower LV volume, and total enhanced mass (all p < 0.05). The infarct zone radial and circumferential strains and radial displacement were higher in the r-LVR group (all p < 0.05). The r-LVR group had better recovery of myocardial injury and function. Of note, microvascular obstruction (MVO) mass (odds ratio: 0.779 (0.613-0.989), p = 0.041) and infarct zone peak longitudinal displacement (PLD) (odds ratio: 1.448 (1.044-2.008), p = 0.026) were independent predictors of r-LVR.
At initial CMR, there were no differences in global cardiac function between the two groups, but infarct zone displacements were higher in the r-LVR group. The r-LVR group had better recovery of cardiac function. In addition, MVO mass and infarct zone PLD were independent predictors of r-LVR.
Our study assessed changes in cardiac structure, function, and tissue characteristics after STEMI by CMR, investigated the best predictors of r-LVR in STEMI patients, and laid the foundation for the development of new parameter-guided treatment strategies for STEMI patients.
• At initial CMR, the reverse left ventricular remodeling (r-LVR) group had less myocardial damage and higher infarct zone displacement, but there were no differences in global function between the two groups. • Both groups showed recovery of myocardial injury and cardiac function over time, but the r-LVR group had less enhanced mass and better cardiac function compared to the without r-LVR group at the second CMR. • Microvascular obstruction mass and infarct zone peak longitudinal displacement by cardiac magnetic resonance feature-tracking were significant predictors of r-LVR in STEMI patients.
评估心脏磁共振（CMR）特征的变化，并探讨 ST 段抬高型心肌梗死（STEMI）患者左心室逆向重构（r-LVR）的预测因素。
回顾性分析 86 例 STEMI 患者（中位年龄 56 岁）。将患者分为 r-LVR 组和非 r-LVR 组。CMR 分析包括 LV 容积、梗死特征、整体和局部心肌功能。通过 CMR 特征跟踪评估应变和位移。采用 logistic 回归方法分析 r-LVR 的预测因素。
r-LVR 组 37 例，非 r-LVR 组 49 例。初始 CMR 时，两组 LV 容积和整体心功能无差异。然而，r-LVR 组梗死区径向和纵向位移较高（分别为 p<0.05）。在第二次 CMR 时，r-LVR 组的 LVEF 更高，LV 容积和总增强质量更低（均为 p<0.05）。r-LVR 组梗死区径向和周向应变以及径向位移较高（均为 p<0.05）。r-LVR 组心肌损伤和功能恢复更好。值得注意的是，微血管阻塞（MVO）质量（比值比：0.779（0.613-0.989），p=0.041）和梗死区峰值纵向位移（PLD）（比值比：1.448（1.044-2.008），p=0.026）是 r-LVR 的独立预测因素。
初始 CMR 时，两组整体心功能无差异，但 r-LVR 组梗死区位移较高。r-LVR 组心功能恢复较好。此外，MVO 质量和梗死区 PLD 是 r-LVR 的独立预测因素。
本研究通过 CMR 评估了 STEMI 后心脏结构、功能和组织特征的变化，探讨了 STEMI 患者 r-LVR 的最佳预测因素，为 STEMI 患者新的参数指导治疗策略的发展奠定了基础。
在初始 CMR 时，r-LVR 组心肌损伤较小，梗死区位移较高，但两组整体功能无差异。
两组均随时间恢复心肌损伤和心功能，但 r-LVR 组第二次 CMR 时增强质量较低，心功能较好。
心脏磁共振特征跟踪显示，微血管阻塞质量和梗死区峰值纵向位移是 STEMI 患者 r-LVR 的显著预测因素。
