Backhaus Sören J, Wolter Jan S, Stiermaier Thomas, Schulz Alexander, Lange Torben, Kutty Shelby, Weferling Maren, Treiber Julia M, Kowallick Johannes T, Hasenfuß Gerd, Rolf Andreas, Sossalla Samuel, Thiele Holger, Eitel Ingo, Schuster Andreas
Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany.
Clin Res Cardiol. 2025 May 26. doi: 10.1007/s00392-025-02666-9.
Load dependence on left ventricular (LV) strain is under constant debate with its interference with prognostic implications remaining unclear. Consequently, we sought to investigate their interaction and prognostic value following acute myocardial infarction (AMI) using state-of-the-art cardiac magnetic resonance (CMR) imaging.
In total, 1235 patients (n = 795 ST-elevation [STEMI] and 440 non-STEMI) underwent CMR in median 3 days following AMI. Infarct characteristics were described by CMR using tissue characterisation (infarct size, microvascular obstruction, area at risk) and deformation imaging including LV global longitudinal and circumferential strain (GLS/GCS). Non-invasive haemodynamic indices included effective arterial elastance Ea (end-systolic pressure (ESP)/stroke volume) and the non-geometric LV end-systolic afterload index NGI [(ESP × LV end-systolic volume (ESV))/LV mass] for estimation of LV afterload. LV contractility was assessed using end-systolic elastance Ees (ESP/LV ESV). Ventriculo-arterial coupling was described as Ea/Ees. Major adverse cardiac events (MACE) were recorded within the first year.
All haemodynamic indices were impaired in patients with MACE during follow-up compared to patients without (p < 0.001-0.005). Ventriculo-arterial coupling showed the highest correlation to infarct properties (infarct size r = 0.51, p < 0.001) and deformation imaging (GLS r = 0.54, GCS r = 0.72, p < 0.001). GLS and GCS were associated with MACE independently of all haemodynamic indices (p < 0.001 for all except of GCS-Ea/Ees p = 0.024).
Non-invasive haemodynamic indices are associated with outcome following AMI with ventriculo-arterial coupling showing the most prominent association to infarct properties and outcome. GCS showed higher correlation to haemodynamic indices compared to GLS whilst both are independent predictors for MACE.
左心室（LV）应变的负荷依赖性一直存在争议，其对预后的影响尚不清楚。因此，我们试图使用先进的心脏磁共振（CMR）成像技术研究急性心肌梗死（AMI）后它们之间的相互作用和预后价值。
总共1235例患者（n = 795例ST段抬高型心肌梗死[STEMI]和440例非STEMI）在AMI后中位3天接受了CMR检查。通过CMR使用组织特征描述梗死特征（梗死面积、微血管阻塞、危险区域）以及包括左心室整体纵向和圆周应变（GLS/GCS）在内的变形成像。无创血流动力学指标包括有效动脉弹性Ea（收缩末期压力[ESP]/每搏输出量）和非几何左心室收缩末期后负荷指数NGI [（ESP×左心室收缩末期容积[ESV]）/左心室质量]，用于估计左心室后负荷。使用收缩末期弹性Ees（ESP/LV ESV）评估左心室收缩性。心室动脉耦联用Ea/Ees表示。在第一年记录主要不良心脏事件（MACE）。
与无MACE的患者相比，随访期间发生MACE的患者所有血流动力学指标均受损（p < 0.001 - 0.005）。心室动脉耦联与梗死特性（梗死面积r = 0.51，p < 0.001）和变形成像（GLS r = 0.54，GCS r = 0.72，p < 0.001）显示出最高的相关性。GLS和GCS与MACE相关，独立于所有血流动力学指标（除GCS - Ea/Ees p = 0.024外，所有p均< 0.001）。
无创血流动力学指标与AMI后的预后相关，心室动脉耦联与梗死特性和预后的相关性最为显著。与GLS相比，GCS与血流动力学指标的相关性更高，而两者都是MACE的独立预测因素。
