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中华心脏与心律电子杂志 ›› 2024, Vol. 12 ›› Issue (01) : 17 -25. doi: 10.3877/cma.j.issn.2095-6568.2024.01.005

心血管影像

基于心脏磁共振多模态特征评估急性心肌梗死患者预后
田欢1, 吴艳凯1, 宋波2, 魏榕辰1, 张艳3, 李月戈1, 武柏林1,()   
  1. 1. 050000 石家庄,河北医科大学第二医院医学影像科
    2. 050013 石家庄,河北医科大学公共卫生学院
    3. 050000 石家庄,河北医科大学第二医院心内科
  • 收稿日期:2023-06-29 出版日期:2024-03-25
  • 通信作者: 武柏林
  • 基金资助:
    河北省医学科学研究课题计划(20221053)

Assess the prognosis of patients with acute myocardial infarction based on cardiac MRI multimodal features

Huan Tian1, Yankai Wu1, Bo Song2, Rongchen Wei1, Yan Zhang3, Yuege Li1, Bailin Wu1,()   

  1. 1. Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
    2. School of Public Health, Hebei Medical University, Shijiazhuang 050013, China
    3. Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Received:2023-06-29 Published:2024-03-25
  • Corresponding author: Bailin Wu
引用本文:

田欢, 吴艳凯, 宋波, 魏榕辰, 张艳, 李月戈, 武柏林. 基于心脏磁共振多模态特征评估急性心肌梗死患者预后[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 17-25.

Huan Tian, Yankai Wu, Bo Song, Rongchen Wei, Yan Zhang, Yuege Li, Bailin Wu. Assess the prognosis of patients with acute myocardial infarction based on cardiac MRI multimodal features[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2024, 12(01): 17-25.

目的

探讨基于心脏磁共振(CMR)的责任病变供血区心肌应变值改变、整体心肌应变和其他CMR参数及部分临床指标对急性心肌梗死(心梗)患者预后的价值评估。

方法

连续纳入2018年12月至2020年12月在河北医科大学第二医院临床确诊为急性心梗并于发病2周内行CMR的患者,记录2019年6月至2021年8月随访期间主要心血管不良事件(MACE)复合终点发生情况(包括出院后全因死亡、心肌再梗死和因新的充血性心力衰竭导致的再住院)。根据是否发生MACE分为MACE组及非MACE组,比较两组患者年龄、性别等基线资料,整体纵向应变(GLS)等CMR参数及白细胞计数等临床相关实验室检查指标,利用单因素、多因素Cox回归分析影响MACE的可能独立危险因素,绘制受试者工作特征曲线(ROC)分析与预后相关指标在MACE中的临界值及诊断效能。

结果

共纳入46例患者,其中非MACE组33例(71.74%,33/46),MACE组13例(28.26%,13/46),包括2例心源性死亡和11例再入院。随访(23.89±12.78)个月。单因素Cox回归分析显示,微血管阻塞(MVO)、责任供血区径向应变、整体径向/纵向应变(GRS/GLS)、左心室射血分数(LVEF)、双平面左心室长轴应变、双平面左心室房室交界长轴应变与MACE的发生相关(P均<0.05)。MVO、GLS是发生恶性结局独立相关的危险因素(MVO:HR 6.69,95%CI 1.49~30.09,P=0.013 2;GLS:HR 2.18,95%CI 1.25~3.80,P=0.006 3)。GLS预测MACE的ROC曲线分析显示,GLS的曲线下面积(AUC)为0.923,GLS截点值为-7.08%,灵敏度84.6%,特异度93.9%。

结论

MVO、GLS是急性心梗患者不良预后的独立危险因素,其中GLS在MACE预测中临床价值显著,预测能力较高。

Objective

To investigate the value of changes in myocardial strain value, overall myocardial strain and other CMR parameters and some clinical indicators based on cardiac magnetic resonance (CMR) in the blood supply area of the responsible lesion on the prognosis of patients with acute myocardial infarction (myocardial infarction).

Methods

Patients who were clinically diagnosed with acute myocardial infarction in The Second Hospital of Hebei Medical University from December 2018 to December 2020 underwent CMR within 2 weeks of onset were continuously selected, and the occurrence of major adverse cardiovascular events (MACE) composite endpoints (including all-cause death after discharge, myocardial reinfarction and rehospitalization due to new congestive heart failure) were recorded during follow-up from June 2019 to August 2021. According to the occurrence of MACE, the MACE group and the non-MACE group were divided, and the baseline data such as age, gender, CMR parameters such as overall longitudinal strain (GLS) and clinically relevant laboratory indicators such as white blood cell count were compared between the two groups. And univariate and multivariate Cox regression analysis was used to analyze the possible independent risk factors affecting MACE. The receiver operating characteristic curve (ROC) was plotted to analyze the critical value and diagnostic performance of the indicators related to prognosis in MACE.

Results

A total of 46 patients were enrolled, including 33 (71.74%, 33/46) in the non-MACE group and 13 (28.26%, 13/46) in the MACE group, including 2 cardiogenic deaths and 11 readmissions. The mean follow-up was (23.89±12.78) months. Univariate Cox regression analysis showed that microvascular occlusion (MVO), radial strain in the responsible blood supply area, global radial/longitudinal strain (GRS/GLS), left ventricular ejection fraction(LVEF), biplanar left ventricular long-axis strain, and biplanar left ventricle atrioventricular junction long-axis strain were associated with the occurrence of MACE (P<0.05). MVO and GLS were independently associated risk factors for malignant outcomes (MVO: HR 6.69, 95%CI 1.49-30.09, P=0.013 2; GLS: HR 2.18, 95%CI 1.25-3.80, P=0.006 3). The ROC curve analysis of GLS prediction MACE showed that the area under the curve (AUC) of GLS was 0.923, the GLS cut-off point value was -7.08%, the sensitivity was 84.6%, and the specificity was 93.9%.

Conclusion

MVO and GLS are independent risk factors for poor prognosis in patients with acute myocardial infarction, and GLS has significant clinical value and high predictive ability in MACE prediction.

图1 急性心肌梗死患者入选流程图
表1 非MACE组与MACE组急性心肌梗死患者基线特征
表2 非MACE组与MACE组急性心肌梗死患者磁共振指标比较
磁共振指标 非MACE组 MACE组 P
责任供血区径向应变[%,MQ1Q3)] 28.78(18.50,42.03) 14.7(10.61,19.56) 0.03
责任供血区周向应变[%,MQ1Q3)] -9.63(-13.97,-6.89) -6.11(-13.56,-3.39) 0.36
责任供血区纵向应变[%MQ1Q3)] -5.85(-7.89,9.12) 0.44(-2.61,5.59) 0.08
GRS[%,MQ1Q3)] 26.27(24.03,36.07) 17.94(15.61,20.91) <0.01
GCS[%,MQ1Q3)] -11.94(-16.04,-8.83) -11.96(-14.67,-10.33) 0.41
GLS(%,
x¯±s
-11.80±4.25 -6.03±1.68 <0.01
LVEDV[ml,MQ1Q3)] 143.13(121.29,167.44) 144.70(118.60,202.53) 0.89
LVESV[ml,MQ1Q3)] 68.87(46.16,100.76) 114.80(59.76,203.02) 0.18
LVEF(%,
x¯±s
49.62±12.85 40.33±9.59 0.02
LVCO(×10ml,
x¯±s
4.90±1.04 4.42±1.03 0.17
RVEDV[ml,MQ1Q3)] 147.23(134.89,163.71) 145.51(143.21,159.73) 0.37
RVESV[ml,MQ1Q3)] 74.13(59.46,98.61) 76.24(74.13,111.99) 0.19
RVEF(%,
x¯±s
49.95±14.98 41.24±17.64 0.10
双平面左心室长轴应变[%,,MQ1Q3)] -13.71(-16.00,-9.69) -7.77(-9.88,-5.35) 0.01
双平面左心室房室交界长轴应变[%,MQ1Q3)] -13.60(-15.65,-9.59) -8.86(-10.24,-5.76) 0.02
双平面左心房长轴应变[%,MQ1Q3)] 15.97(12.17,25.80) 8.78(5.67,25.60) 0.44
双平面左心房房室交界长轴应变[%,MQ1Q3)] 15.14(5.94,23.43) 8.56(3.66,22.98) 0.43
MVO[例(%)] 12(36.36) 10(76.92) 0.01
透壁程度[例(%)] 0.09
≤50 24(72.73) 6(46.15)
>50 9(27.27) 7(53.85)
图2 Cox回归分析森林图[2A为单因素分析Cox回归分析;2B为多因素Cox回归分析]HR为风险比,CI为可信区间,LVEF为左心室射血分数,GLS为整体纵向应变,GRS为整体径向应变,MVO为微血管阻塞
图3 整体纵向应变、双平面左心室长轴应变、双平面左心室房室交界长轴应变等预测MACE的受试者工作特征曲线分析
表3 GLS、双平面左心室长轴应变、双平面左心室房室交界长轴应变等预测主要心血管不良事件(MACE)的受试者工作特征曲线下面积比较
图4 整体纵向应变与不同CMR参数相关性[4A为整体纵向应变与左心室射血分数相关性;4B为整体纵向应变与左心室收缩末期容积相关性;4C为整体纵向应变与左心室舒张末期容积相关性;4D为整体纵向应变与左心室排血量相关性;4E为整体纵向应变与右心室射血分数相关性;4F为整体纵向应变与右心室收缩末期容积相关性;4G为整体纵向应变与右心室舒张末期容积相关性]GLS为整体纵向应变,LVEF为左心室射血分数,LVESV为左心室收缩末容积,LVEDV为左心室舒张末容积,LVCO为左心室排血量;RVEF为右心室射血分数,RVESV为右心室收缩末容积,RVEDV为右心室舒张末容积
图5 亚组的Kaplan–Meier生存曲线。[5A为整体纵向应变;5B为微血管阻塞;5C为双平面左心室长轴应变;5D为双平面左心室房室交界长轴应变;5E为责任供血区径向应变;5F为整体径向应变;5G为左心室射血分数]MACE为主要心血管不良事件,心梗为心肌梗死
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