组织追踪心脏磁共振成像测量应变在非阻塞性冠状动脉心肌梗死中的预后价值
Prognostic Value of Strain by Tissue Tracking Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries.
作者信息
Chen Lei, Qiu Bowen, Abdu Fuad A, Liu Lu, Zhang Wen, Wang Chunyue, Alifu Jiasuer, Qi Penglong, Che Wenliang, Lu Yuan
机构信息
Department of Cardiology Shanghai Tenth People's Hospital, Tongji University School of Medicine Shanghai China.
Department of Cardiology The Affiliated Hospital of Xuzhou Medical University Xuzhou China.
出版信息
J Am Heart Assoc. 2025 Apr 15;14(8):e039395. doi: 10.1161/JAHA.124.039395. Epub 2025 Apr 7.
BACKGROUND
Strain assessed by cardiac magnetic resonance (CMR) is a key prognostic indicator in myocardial infarction. However, the strain characteristics and prognostic value in myocardial infarction with nonobstructive coronary arteries (MINOCA) with different causes are unclear. This study aims to describe left atrial (LA) and left ventricular strain in patients with MINOCA and evaluate their predictive value for major adverse cardiovascular events (MACEs) in "true MINOCA" cases.
METHODS AND RESULTS
This single-center retrospective study included patients suspected of myocardial infarction who completed CMR during hospitalization. CMR images were used to obtain LA and left ventricular strain via CMR feature tracking. True MINOCA was defined by evidence of ischemia or infarction on CMR. MACEs included all-cause death, recurrent myocardial infarction, stroke, heart failure, atrial fibrillation, and angina pectoris. This study included 386 patients, with a median time from admission to CMR of 4 days. LA and left ventricular strains varied by pathogenesis, with the lowest strain in patients with cardiomyopathy. For patients with true MINOCA, Cox regression showed that global longitudinal strain (hazard ratio [HR], 0.90 [95% CI, 0.82-0.99]; =0.022) and LA reservoir strain (HR, 0.95 [95% CI, 0.91-0.99]; =0.014) were independently associated with MACEs. Kaplan-Meier analysis indicated that patients with LA reservoir strain ≤21.25% or global longitudinal strain ≤16.4% had a significantly higher MACE risk (<0.001). Integrating global longitudinal strain and LA reservoir strain improved MACE prediction.
CONCLUSIONS
LA and left ventricular strains vary among MINOCA pathogeneses. In true MINOCA patients, global longitudinal strain and LA reservoir strains independently predict MACE risk. Integrating these strains enhances MACE prediction.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique Identifier: NCT06502899.
背景
通过心脏磁共振成像（CMR）评估的应变是心肌梗死的关键预后指标。然而，不同病因的非阻塞性冠状动脉心肌梗死（MINOCA）的应变特征和预后价值尚不清楚。本研究旨在描述MINOCA患者的左心房（LA）和左心室应变，并评估其对“真性MINOCA”病例主要不良心血管事件（MACE）的预测价值。
方法和结果
这项单中心回顾性研究纳入了住院期间完成CMR检查的疑似心肌梗死患者。通过CMR特征追踪利用CMR图像获取LA和左心室应变。真性MINOCA由CMR上的缺血或梗死证据定义。MACE包括全因死亡、复发性心肌梗死、中风、心力衰竭、心房颤动和心绞痛。本研究纳入了386例患者，从入院到CMR检查的中位时间为4天。LA和左心室应变因发病机制而异，心肌病患者的应变最低。对于真性MINOCA患者，Cox回归显示，整体纵向应变（风险比[HR]，0.90[95%置信区间，0.82 - 0.99]；P = 0.022）和LA储备应变（HR，0.95[95%置信区间，0.91 - 0.99]；P = 0.014）与MACE独立相关。Kaplan - Meier分析表明，LA储备应变≤21.25%或整体纵向应变≤16.4%的患者发生MACE的风险显著更高（P < 0.001）。整合整体纵向应变和LA储备应变可改善MACE预测。
结论
MINOCA发病机制中LA和左心室应变各不相同。在真性MINOCA患者中，整体纵向应变和LA储备应变可独立预测MACE风险。整合这些应变可增强MACE预测。
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