知识与财富的链接
目的:评估基于心脏磁共振成像(CMR)的整体纵向应变(GLS)对于接受经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者主要心血管事件的预测价值。方法:纳入2016—2020年在国内多个三甲医院急诊行直接PCI的487例STEMI患者,所有患者在直接PCI术后1周[(7±2)d]进行CMR,获得GLS、整体径向应变(GRS)、整体周向应变(GCS)、左心室射血分数(LVEF)、心肌梗死面积(IS)和微血管阻塞(MVO)。随访5年,主要终点是5年内全因死亡、再发心肌梗死、因心力衰竭需要急诊住院治疗以及因不稳定性心绞痛进行的非预期PCI手术的复合终点。根据是否出现主要终点事件分为预后不良组和预后良好组,采用Cox回归分析CMR应变参数对STEMI预后不良的预测价值。结果:随访中共有136例患者出现主要不良心血管事件。预后不良组IS和MVO更高(均P<0.001),GLS、GCS的绝对值更小(均P<0.001),GRS、LVEF更小(均P<0.001)。在Cox分析模型中校正年龄、MVO、IS等危险因素后,GLS(HR=1.172,95%CI:1.100～1.250,P<0.001)是预后不良的独立预测因子。在心血管不良事件的ROC曲线分析中,GLS是比LVEF、GCS、GRS和IS更强的预测因子。结论:基于CMR的GLS是经PCI治疗的STEMI患者不良预后的独立危险因素。
ObjectiveTo evaluate the predictive value of global longitudinal strain (GLS) measured by cardiac magnetic resonance (CMR) feature-tracking for long-term prognosis after primary percutaneous coronary intervention(PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).MethodsA total of 487 patients underwent PCI in five hospitals from August 2018 to September 2020 were recruited. CMR examinations were performed one week (7±2 days) after myocardial infarction to obtain GLS, global radial strain (GRS), global circumferential strain (GCS), left ventricular ejection fraction (LVEF), infarct size (IS) and microvascular obstruction (MVO). The primary endpoint was a composite of all-cause death, recurrent infarction, hospitalization for new-onset congestive heart failure and unplanned revascularization for unstable angina within 5 years. Patients were divided into two groups based on whether the primary endpoint event occurred. Cox regression analysis was performed to evaluate the predictive value of CMR parameters for poor prognosis.ResultsThe five-year follow-up results showed 136 patients had a poor prognosis among the 487 patients enrolled. The patients in the poor prognosis group had significantly higher IS and MVO (both P < 0.001), higher GLS and GCS (both P < 0.001), and lower GRS and LVEF (both P < 0.001). Cox regression analysis indicated that GLS was an independent predictor of poor prognosis after adjustment for age, MVO, and IS. ROC curve analysis showed that GLS was a stronger predictor than LVEF, GCS, GRS and IS.ConclusionGLS is an independent risk factor of poor prognosis in patients with STEMI after PCI.
