Garg Pankaj, Bana Aradhai, Matthews Gareth, Bali Tiya, Li Rui, Mehmood Zia, Zhong Liang, van der Geest Rob J, Plein Sven, Greenwood John P, Swoboda Peter
The Bob Champion Research & Education Building, Rosalind Franklin Road, University of East Anglia, Norwich NR4 7UQ, UK.
Cardiology Department, Colney Lane, Norfolk and Norwich University Teaching Hospitals, Norwich NR4 7UY, UK.
Eur Heart J Imaging Methods Pract. 2025 Jul 25;3(2):qyaf086. doi: 10.1093/ehjimp/qyaf086. eCollection 2025 Jul.
Cardiovascular magnetic resonance (CMR)-derived pulmonary capillary wedge pressure (PCWP) has demonstrated diagnostic and prognostic utility in heart failure patients. However, its clinical value in acute myocardial infarction (AMI) remains undetermined. This study investigates the relationship between CMR-derived PCWP, myocardial injury, and left ventricular (LV) remodelling in re-perfused acute ST-elevation myocardial infarction (STEMI).
Sixty-nine patients with STEMI underwent CMR within 48 h and at 3 months. PCWP was estimated using the sex-specific equation: CMR PCWP: 5.7591 + (0.07505 × left atrial volume) [0.05289 × left ventricular mass (LVM)] - (1.9927 × sex) [female = 0; male = 1], where LAV is left atrial volume (mL) and LVM is left ventricular mass (g). LV remodelling was assessed via changes in LV end-diastolic volume (LVEDV) and ejection fraction (LVEF). Patients with high CMR PCWP (≥18 mmHg) exhibited greater myocardial scar burden (28.5% vs. 17.2%, = 0.0008) and microvascular obstruction (7.6% vs. 2.5%, < 0.0001). They also had higher acute LVEDV (193.7 ± 39.7 vs. 158.0 ± 29.5 mL, < 0.0001) and lower LVEF (41.4 ± 10.4% vs. 48.5 ± 9.2%, = 0.0066). At follow-up, higher baseline CMR PCWP was associated with greater LV remodelling ( < 0.0001) and persistently reduced LVEF (45.4 ± 10.2% vs. 55.0 ± 10.3%, = 0.0005). Regression analysis confirmed baseline PCWP as an independent predictor of follow-up LVEF ( = 0.0036).
CMR-derived PCWP may be a valuable biomarker in STEMI, identifying patients at risk of adverse remodelling and LV dysfunction. Its integration into clinical practice may enhance risk stratification and guide targeted therapies.
心血管磁共振（CMR）衍生的肺毛细血管楔压（PCWP）已在心力衰竭患者中显示出诊断和预后价值。然而，其在急性心肌梗死（AMI）中的临床价值仍未确定。本研究调查了CMR衍生的PCWP、心肌损伤和再灌注急性ST段抬高型心肌梗死（STEMI）患者左心室（LV）重构之间的关系。
69例STEMI患者在48小时内及3个月时接受了CMR检查。使用性别特异性方程估算PCWP：CMR PCWP = 5.7591 +（0.07505×左心房容积） - （0.05289×左心室质量（LVM）） - （1.9927×性别）[女性 = 0；男性 = 1]，其中LAV是左心房容积（mL），LVM是左心室质量（g）。通过左心室舒张末期容积（LVEDV）和射血分数（LVEF）的变化评估LV重构。CMR PCWP高（≥18 mmHg）的患者表现出更大的心肌瘢痕负担（28.5%对17.2%，P = 0.0008）和微血管阻塞（7.6%对2.5%，P < 0.0001）。他们还具有更高的急性LVEDV（193.7±39.7对158.0±29.5 mL，P < 0.0001）和更低的LVEF（41.4±10.4%对48.5±9.2%，P = 0.
