Oketunbi Temilola J, Wang Jun, Ding Bin, Song Xilong, Li Yao, Song Hongwei, Shi Xiaojun, Hu Sigang, Gao Dasheng, Wang Hongju, Li Miaonan
Department of Cardiovascular Diseases, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China.
Department of Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China.
BMC Cardiovasc Disord. 2025 Apr 10;25(1):274. doi: 10.1186/s12872-025-04719-3.
Myocardial fibrosis is a prevalent pathological hallmark of a diverse range of chronic and acute cardiovascular disorders. However, the relevant literature currently provides limited evidence regarding the determinants of myocardial fibrosis severity in patients with new-onset ST-elevation myocardial infarction (STEMI) following successful emergent percutaneous coronary intervention (PCI) utilizing contrast-enhanced cardiac magnetic resonance imaging (CE-CMR).
We prospectively enrolled a cohort of 78 patients who presented with new-onset ST-segment elevation myocardial infarction and who underwent successful emergent PCI within 12 h from the onset of symptoms. Late gadolinium-enhanced LGE (LGE) was quantified via CE-CMR, and patients were categorized into two groups on the basis of the median LGE value.
The median LGE was 16% (IQR 12 to 24). Compared with patients with LGE below the median (n = 37), those with LGE above the median (n = 41) presented significantly reduced left ventricular global radial strain(GRS), global circumferential strain(GCS), and global longitudinal strain(GLS) (all p < 0.05). The infarcted radial segment (IRS), infarcted circumferential segment (ICS) and infarcted longitudinal segment (ILS) were significantly reduced in patients with greater LGE (all p < 0.05). The occurrence rates of microvascular obstruction (MVO) (p < 0.001) and wall motion abnormality (WMA) (p < 0.01) were significantly greater in patients with a greater extent of LGE, despite successful reperfusion therapy. LGE exhibited a moderate negative correlation with the global circumferential segment (r=-0.547, p < 0.001) and a weak negative correlation with both the global radial segment and the global longitudinal segment (r=-0.434, p < 0.001; r=-0.437, p < 0.001). In the multivariable linear regression analysis model, the Gensini score (β = 0.258; p < 0.01), LVEF% (β=-0.269; p < 0.05), MVO (β = 0.343; p < 0.001) and GRS (β = 0.227; p < 0.05) emerged as robust predictors of myocardial fibrosis.
The present study revealed a correlation of cardiac pathological structure, microcirculation, and myocardial fibrosis in the context of acute myocardial infarction. Therefore, this study provides theoretical evidence from a pathological perspective regarding the progression of myocardial fibrosis in patients with new-onset STEMI following successful PCI.
The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2400080282; January 25th, 2024).
心肌纤维化是多种急慢性心血管疾病普遍存在的病理特征。然而，目前相关文献中关于采用对比增强心脏磁共振成像（CE-CMR）对首次发生ST段抬高型心肌梗死（STEMI）患者成功进行急诊经皮冠状动脉介入治疗（PCI）后心肌纤维化严重程度的决定因素的证据有限。
我们前瞻性纳入了一组78例首次发生ST段抬高型心肌梗死且在症状发作后12小时内成功进行急诊PCI的患者。通过CE-CMR对延迟钆增强（LGE）进行定量分析，并根据LGE值的中位数将患者分为两组。
LGE的中位数为16%（四分位间距12%至24%）。与LGE低于中位数的患者（n = 37）相比，LGE高于中位数的患者（n = 41）左心室整体径向应变（GRS）、整体圆周应变（GCS）和整体纵向应变（GLS）均显著降低（均p < 0.05）。LGE较高的患者梗死径向节段（IRS）、梗死圆周节段（ICS）和梗死纵向节段（ILS）均显著减少（均p < 0.05）。尽管进行了成功的再灌注治疗，但LGE程度较高的患者微血管阻塞（MVO）（p < 0.001）和室壁运动异常（WMA）（p < 0.01）的发生率显著更高。LGE与整体圆周节段呈中度负相关（r = -0.547，p < 0.001），与整体径向节段和整体纵向节段均呈弱负相关（r = -0.434，p < 0.001；r = -0.437，p < 0.001）。在多变量线性回归分析模型中，Gensini评分（β = 0.258；p < 0.01）、左心室射血分数百分比（LVEF%）（β = -0.269；p < 0.05）、MVO（β = 0.343；p < 0.001）和GRS（β = 0.227；p < 0.05）是心肌纤维化的有力预测指标。
本研究揭示了急性心肌梗死背景下心脏病理结构、微循环与心肌纤维化之间的相关性。因此，本研究从病理角度为首次发生STEMI患者成功PCI后心肌纤维化的进展提供了理论依据。
该试验已在中国临床试验注册中心注册（ChiCTR2400080282；2024年1月25日）。
