南方医科大学学报

南方医科大学学报 ›› 2024, Vol. 44 ›› Issue (6): 1033-1039.doi: 10.12122/j.issn.1673-4254.2024.06.03

• • 上一篇    

心脏磁共振成像整体纵向应变对急性ST段抬高型心肌梗死后左心室重构的预测价值：403例前瞻性研究

刘科1,2(), 马振岩1, 付磊1, 张丽萍2, 阿鑫2, 肖少波1, 张震1, 张洪博3, 赵蕾3, 钱赓1,2()   

  1. 1.解放军医学院，北京 100853
    2.中国人民解放军总医院第六医学中心心血管病医学部，北京 100048
    3.首都医科大学附属北京安贞医院放射科心内科，北京 100029
  • 收稿日期:2024-01-16 出版日期:2024-06-20 发布日期:2024-07-01
  • 通讯作者: 钱赓 E-mail:997036483@qq.com;qiangeng9396@263.net
  • 作者简介:刘 科，在读硕士研究生，E-mail: 997036483@qq.com
  • 基金资助:
    中华心血管病发展专项基金心脏健康科研基金项目(Z-2017-26-2202-2);首都卫生发展科研专项项目(SF2020-2-5012)

Predictive value of global longitudinal strain measured by cardiac magnetic resonance imaging for left ventricular remodeling after acute ST-segment elevation myocardial infarction: a multi-centered prospective study

Ke LIU1,2(), Zhenyan MA1, Lei FU1, Liping ZHANG2, Xin A2, Shaobo XIAO1, Zhen ZHANG1, Hongbo ZHANG3, Lei ZHAO3, Geng QIAN1,2()   

  1. 1.Medical School of Chinese PLA, Beijing 100853, China
    2.Senior Department of Cardiology Disease Medicine, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
    3.Department of Cardiology and Radiology, Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China
  • Received:2024-01-16 Online:2024-06-20 Published:2024-07-01
  • Contact: Geng QIAN E-mail:997036483@qq.com;qiangeng9396@263.net

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摘要：

目的 分析心脏磁共振成像（CMR）特征追踪技术测量的整体纵向应变（GLS）对急性ST段抬高型心肌梗死（STEMI）患者接受经皮冠状动脉介入治疗后（PCI）左心室重构（LVR）的预测价值。 方法 前瞻性纳入来自国内多中心的经PCI术后的STEMI患者共403例，分别于心肌梗死后1周（7±2 d）和6月进行CMR检查，获得GLS、整体径向应变（GRS）、整体周向应变（GCS）、射血分数（LVEF）和心肌梗死面积（IS）。主要终点为LVR，其定义是随访中通过CMR检查左心室舒张末期容积从基线到6月增加≥20%或左心室收缩末期容积增加≥15%，根据LVR的发生情况将患者分为LVR组（n=101）和无LVR组（n=302）。采用Logistic回归分析CMR参数对LVR的预测价值。 结果 与无LVR组相比，LVR组的GLS、GCS更大（P<0.001），GRS、LVEF更小（P<0.001）。Logistic回归分析显示，GLS（OR：1.387，95%CI：1.223~1.573，P<0.001）和LVEF（OR：0.951，95%CI：0.914~0.990，P=0.015）是LVR的独立预测因子。ROC曲线分析显示，GLS预测LVR的最佳临界值为-10.6%，灵敏度为74.3%，特异度为71.9%。GLS预测LVR的AUC与LVEF的差异无统计学意义（P=0.146），但优于GCS、GRS和IS等其他参数（P<0.05）。LVEF与其他参数的AUC差异无统计学意义（P>0.05）。 结论 基于CMR测定的GLS是STEMI患者PCI术后LVR的重要预测因子，与GRS、GCS、IS和LVEF相比具有明显的优势。

关键词: 急性ST段抬高型心肌梗死, 心脏磁共振成像特征追踪, 心肌应变, 左心室重构

Abstract:

Objective To evaluate the predictive value of global longitudinal strain (GLS) measured by cardiac magnetic resonance (CMR) feature-tracking technique for left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 403 patients undergoing PCI for acute STEMI were prospectively recruited from multiple centers in China. CMR examinations were performed one week (7±2 days) and 6 months after myocardial infarction to obtain GLS, global radial strain (GRS), global circumferential strain (GCS), ejection fraction (LVEF) and infarct size (IS). The primary endpoint was LVR, defined as an increase of left ventricle end-diastolic volume by ≥20% or an increase of left ventricle end-systolic volume by ≥15% from the baseline determined by CMR at 6 months. Logistic regression analysis was performed to evaluate the predictive value of CMR parameters for LVR. Results LVR occurred in 101 of the patients at 6 months after myocardial infarction. Compared with those without LVR (n=302), the patients in LVR group exhibited significantly higher GLS and GCS (P<0.001) and lower GRS and LVEF (P<0.001). Logistic regression analysis indicated that both GLS (OR=1.387, 95% CI: 1.223-1.573; P<0.001) and LVEF (OR=0.951, 95% CI: 0.914-0.990; P=0.015) were independent predictors of LVR. ROC curve analysis showed that at the optimal cutoff value of -10.6%, GLS had a sensitivity of 74.3% and a specificity of 71.9% for predicting LVR. The AUC of GLS was similar to that of LVEF for predicting LVR (P=0.146), but was significantly greater than those of other parameters such as GCS, GRS and IS (P<0.05); the AUC of LVEF did not differ significantly from those of the other parameters (P>0.05). Conclusion In patients receiving PCI for STEMI, GLS measured by CMR is a significant predictor of LVR occurrence with better performance than GRS, GCS, IS and LVEF.

Key words: acute ST-segment elevation myocardial infarction, cardiac magnetic resonance feature tracking, myocardial strain, left ventricular remodeling