Wei Lai, Dong Jian-Xun, Jin Li-Xing, He Jie, Zhao Chen-Xu, Kong Ling-Cong, An Dong-Ao-Lei, Ding Song, Yang Fan, Yang Yi-Ning, Yan Fu-Hua, Xiu Jian-Cheng, Wang Hu-Wen, Ge Heng, Pu Jun
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Radiol Med. 2023 Nov;128(11):1372-1385. doi: 10.1007/s11547-023-01700-y. Epub 2023 Aug 28.
The prognostic role of diastolic dysfunction measured by the circumferential peak early diastolic strain rate (PEDSR) on ST-elevation myocardial infarction (STEMI) is not completely established.
We aimed to investigate the prognostic value of diastolic function by measuring PEDSR within 1 week after STEMI.
The cardiac magnetic resonance (CMR) pictures of 420 subjects from a clinical registry study (NCT03768453) were analyzed and the composite major adverse cardiac events (MACEs) were followed up.
The PEDSR of patients was significantly lower compared with that of control subjects (P < 0.001). Within the median follow-up period of 52 months, PEDSR of patients who experienced MACEs deceased more significantly than that of patients without MACEs (P < 0.001). After adjusting with clinical or CMR indexes, per 0.1/s reduction of PEDSR increased the risks of MACEs to 1.402 or 1.376 fold and the risk of left ventricular (LV) remodeling to 1.503 or 1.369 fold. When PEDSR divided by best cutoff point, significantly higher risk of MACEs (P < 0.001) and more remarkable LV remodeling (P < 0.001) occurred in patients with PEDSR ≤ 0.485/s. Moreover, when adding the PEDSR to the conventional prognostic factors such as LV ejection fraction and infarction size, better prognostic risk classification models were created. Finally, aging, tobacco use, remarkable LV remodeling, and a low LV ejection fraction were factors related with the reduction of PEDSR.
Diastolic dysfunction has an important prognostic effect on patients with STEMI. Measurement of the PEDSR in the acute phase could serve as an effective index to predict the long-term risk of MACEs and cardiac remodeling.
通过圆周早期舒张应变率（PEDSR）测量的舒张功能障碍对ST段抬高型心肌梗死（STEMI）的预后作用尚未完全明确。
我们旨在通过测量STEMI后1周内的PEDSR来研究舒张功能的预后价值。
分析了一项临床注册研究（NCT03768453）中420名受试者的心脏磁共振（CMR）图像，并对复合主要不良心脏事件（MACE）进行随访。
患者的PEDSR显著低于对照组（P < 0.001）。在52个月的中位随访期内，发生MACE的患者的PEDSR下降幅度比未发生MACE的患者更显著（P < 0.001）。在调整临床或CMR指标后，PEDSR每降低0.1/s，MACE风险增加至1.402倍或1.376倍，左心室（LV）重构风险增加至1.503倍或1.369倍。当PEDSR除以最佳截断点时，PEDSR≤0.485/s的患者发生MACE的风险显著更高（P < 0.001），LV重构更明显（P < 0.001）。此外，将PEDSR添加到左心室射血分数和梗死面积等传统预后因素中，可创建更好的预后风险分类模型。最后，衰老、吸烟、显著的LV重构和低左心室射血分数是与PEDSR降低相关的因素。
舒张功能障碍对STEMI患者具有重要的预后影响。急性期测量PEDSR可作为预测MACE长期风险和心脏重构的有效指标。
