急性ST段抬高型心肌梗死经皮冠状动脉介入术后左心室不良重构的新型风险预测模型：基于心脏磁共振的多中心前瞻性研究

doi:10.12122/j.issn.1673-4254.2025.04.01

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (4): 669-683.doi: 10.12122/j.issn.1673-4254.2025.04.01

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急性ST段抬高型心肌梗死经皮冠状动脉介入术后左心室不良重构的新型风险预测模型：基于心脏磁共振的多中心前瞻性研究

马振岩¹(), 阿鑫², 赵蕾³, 张洪博³, 刘科¹, 赵依晴¹, 钱赓⁴()

^1.中国人民解放军医学院，北京 100039
^2.中国人民解放军总医院第二医学中心保健七科，北京 100039
^3.首都医科大学附属北京安贞医院放射科，北京 100029
^4.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

收稿日期:2025-01-09 出版日期:2025-04-20 发布日期:2025-04-28
通讯作者: 钱赓 E-mail:mzy20130309@163.com;qiangeng9396@263.net
作者简介:马振岩，在读硕士研究生，E-mail: mzy20130309@163.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-2019-42-1908-2);首都卫生发展科研专项项目(SF2020-2-5012)

A cardiac magnetic resonance-based risk prediction model for left ventricular adverse remodeling following percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a multi-center prospective study

Zhenyan MA¹(), Xin A², Lei ZHAO³, Hongbo ZHANG³, Ke LIU¹, Yiqing ZHAO¹, Geng QIAN⁴()

^1.Medical School of Chinese PLA, Beijing 100039, China
^2.Seventh Department of Health Care, Second Medical Center, Chinese PLA General Hospital, Beijing 100039, China
^3.Department of Radiology, Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China
^4.Senior Department of Cardiology Disease Medicine, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China

Received:2025-01-09 Online:2025-04-20 Published:2025-04-28
Contact: Geng QIAN E-mail:mzy20130309@163.com;qiangeng9396@263.net

摘要/Abstract

摘要：

目的基于急性ST段抬高型心肌梗死（STEMI）患者的心脏磁共振（CMR）参数构建左心室不良重构（LVAR）风险预测模型。方法前瞻性纳入2018年1月~2021年12月在8个医学中心接受直接经皮冠状动脉介入治疗（PCI）的急性STEMI患者329例。分别于PCI术后7±2 d及术后6个月进行CMR检查。采用CVI42软件分析CMR参数。LVAR定义为PCI术后6月左心室舒张末期容积较基线（术后7±2 d）增加超过20%，或左心室收缩末期容积较基线增加超过15%。所有患者按照7∶3的比例随机分为训练集（n=230）和验证集（n=99）。在训练集中，首先通过LASSO回归筛选出潜在的预测因子，然后进行单因素和多因素Logistic回归分析，以识别具有独立预测价值的变量，并构建列线图。通过受试者工作特征曲线、曲线下面积（AUC）、校准曲线和决策曲线分析，评估列线图在训练集和验证集中的区分度、校准度和临床应用价值。结果根据LVAR的定义，患者分为LVAR组（n=100，30.40%）和无重构组（n=229，69.60%）。LVAR组心血管主要不良事件发生率明显高于无重构组（58.00% vs 16.16%，P<0.001）。单因素和多因素Logistic回归分析发现，左心室整体纵向应变（LVGLS）［OR=0.76，95% CI （0.61-0.95），P=0.015］、左心房主动应变（LAAS）［OR=0.78，95% CI （0.67-0.92），P=0.003］是LVAR的保护因素。而梗死面积（IS）［OR=1.05，95% CI（1.01-1.10），P=0.017］、微血管阻塞（MVO）［OR=1.26，95% CI（1.01-1.59），P=0.048］是LVAR的危险因素。列线图在训练集中的AUC值为 0.90 （95% CI：0.86-0.94），在验证集中AUC值为 0.88 （95% CI：0.81-0.94）。结论本研究基于急性STEMI患者的CMR参数，识别出4个LVAR的独立预测因子：LVGLS、LAAS、IS、MVO。基于这4个变量构建的列线图预测性能良好，可为急性STEMI患者的临床管理和早期干预提供重要依据。

关键词: 左心室不良重构, 急性ST段抬高型心肌梗死, 心脏磁共振, 列线图

Abstract:

Objective To develop a risk prediction model for left ventricular adverse remodeling (LVAR) based on cardiac magnetic resonance (CMR) parameters in patients undergoing percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 329 acute STEMI patients undergoing primary PCI at 8 medical centers from January, 2018 to December, 2021 were prospectively enrolled. The parameters of CMR, performed at 7±2 days and 6 months post-PCI, were analyzed using CVI42 software. LVAR was defined as an increase >20% in left ventricular end-diastolic volume or >15% in left ventricular end-systolic volume at 6 months compared to baseline. The patients were randomized into training (n=230) and validation (n=99) sets in a 7∶3 ratio. In the training set, potential predictors were selected using LASSO regression, followed by univariate and multivariate logistic regression to construct a nomogram. Model performance was evaluated using receiver-operating characteristic (ROC) curves, area under the curve (AUC), calibration curves, and decision curve analysis. Results LVAR occurred in 100 patients (30.40%), who had a higher incidence of major adverse cardiovascular events than those without LVAR (58.00% vs 16.16%, P<0.001). Left ventricular global longitudinal strain (LVGLS; OR=0.76, 95% CI: 0.61-0.95, P=0.015) and left atrial active strain (LAAS; OR=0.78, 95% CI: 0.67-0.92, P=0.003) were protective factors for LVAR, while infarct size (IS; OR=1.05, 95% CI: 1.01-1.10, P=0.017) and microvascular obstruction (MVO; OR=1.26, 95% CI: 1.01-1.59, P=0.048) were risk factors for LVAR. The nomogram had an AUC of 0.90 (95% CI: 0.86-0.94) in the training set and an AUC of 0.88 (95% CI: 0.81-0.94) in the validation set. Conclusion LVGLS, LAAS, IS, and MVO are independent predictors of LVAR in STEMI patients following PCI. The constructed nomogram has a strong predictive ability to provide assistance for management and early intervention of LVAR.

Key words: left ventricular adverse remodeling, acute ST-elevation myocardial infarction, cardiac magnetic resonance, nomogram

马振岩, 阿鑫, 赵蕾, 张洪博, 刘科, 赵依晴, 钱赓. 急性ST段抬高型心肌梗死经皮冠状动脉介入术后左心室不良重构的新型风险预测模型：基于心脏磁共振的多中心前瞻性研究[J]. 南方医科大学学报, 2025, 45(4): 669-683.

Zhenyan MA, Xin A, Lei ZHAO, Hongbo ZHANG, Ke LIU, Yiqing ZHAO, Geng QIAN. A cardiac magnetic resonance-based risk prediction model for left ventricular adverse remodeling following percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a multi-center prospective study[J]. Journal of Southern Medical University, 2025, 45(4): 669-683.

图/表 14

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Variables	Total (n=329)	Non-LVAR (n=229)	LVAR (n=100)	P
Demographics
Age (year)	58±10.8	58±10.6	58±11.5	0.944
Female [n (%)]	41 (12.46)	32 (13.97)	9 (9.00)	0.209
SBP (mmHg)	125±20	126±20	124±18	0.445
DBP (mmHg)	76±13	76±13	77±14	0.244
HR (beats/min)	79±13	79±13	79±12	0.872
BMI (kg/m²)	25.4±3.3	25.4±3.3	25.4±3.3	0.939
Killip classes				0.330
Ⅰ	254 (77.20)	182 (79.48)	72 (72.00)
Ⅱ	64 (19.45)	40 (17.47)	24 (24.00)
Ⅲ	11 (3.34)	7 (3.06)	4 (4.00)
Laboratory tests
Hb (g/L)	148.3±15.2	148.1±15.1	148.8±15.5	0.685
WBC (10⁹/L)	10.81±3.46	10.39±3.27	11.79±3.69	0.001*
Glucose (mmol/L)	8.26±3.59	8.04±3.23	8.75±4.27	0.100
Cr (µmol/L)	77.84±18.44	78.43±18.43	76.49±18.49	0.382
LDL-C (mmol/L)	3.09±0.94	3.10±0.90	3.07±1.01	0.789
TC (mmol/L)	4.60±1.12	4.63±1.11	4.54±1.14	0.515
TG (mmol/L)	1.63±0.96	1.68±1.03	1.51±0.77	0.145
NT-proBNP (pg/mL)	134.50 (51.50, 321.80)	124.00 (51.64, 251.50)	149.00 (50.72, 498.95)	0.052
Peak cTnT (ng/mL)	9.95 (4.04, 24.76)	8.22 (3.24, 21.80)	18.92 (6.53, 40.85)	<0.001*
Peak CK-MB (ng/mL)	165.80 (65.00, 257.00)	143.70 (59.79, 238.20)	216.40 (125.05, 301.50)	<0.001*
Medical history [n (%)]
Hypertension	179 (54.41)	122 (53.28)	57 (57.00)	0.533
Diabetes mellitus	81 (24.62)	57 (24.89)	24 (24.00)	0.863
Hyperlipidemia	141 (42.86)	93 (40.61)	48 (48.00)	0.213
Stroke	19 (5.78)	11 (4.80)	8 (8.00)	0.253
Current smoker	204 (62.01)	142 (62.01)	62 (62.00)	0.999
Medical therapy [n (%)]
ACEI/ARB	162 (49.24)	115 (50.22)	47 (47.00)	0.591
Beta-blocker	267 (81.16)	184 (80.35)	83 (83.00)	0.572
MRA	56 (17.02)	35 (15.28)	21 (21.00)	0.204
ARNI	167 (50.76)	114 (49.78)	53 (53.00)	0.591
SGLT2I	86 (26.14)	61 (26.64)	25 (25.00)	0.756
Antiplatelet agents	329 (100)	229 (100)	100 (100.00)	1.000
Statin	326 (99.09)	227 (99.13)	99 (99.00)	1.000
Angiographic features [n (%)]
MI location				<0.001*
Anterior MI	154 (46.81)	90 (39.30)	64 (64.00)
Non-Anterior MI	175 (53.19)	139 (60.70)	36 (36.00)
Number of diseased vessels				0.254
1	172 (52.28)	113 (49.34)	59 (59.00)
2	84 (25.53)	61 (26.64)	23 (23.00)
3	73 (22.19)	55 (24.02)	18 (18.00)
Culprit vessel				<0.001*
LAD	168 (51.06)	101 (44.10)	67 (67.00)
LCX	41 (12.46)	30 (13.10)	11 (11.00)
RCA	120 (36.47)	98 (42.79)	22 (22.00)
Number of stents				0.529
0	16 (4.86)	9 (3.93)	7 (7.00)
1	228 (69.30)	162 (70.74)	66 (66.00)
2	65 (19.76)	43 (18.78)	22 (22.00)
3	20 (6.08)	15 (6.55)	5 (5.00)
TIMI flow before PCI				0.096
0	254 (77.20)	168 (73.36)	86 (86.00)
1	12 (3.65)	10 (4.37)	2 (2.00)
2	27 (8.21)	22 (9.61)	5 (5.00)
3	36 (10.94)	29 (12.66)	7 (7.00)
TIMI flow after PCI				0.274
0	1 (0.30)	1 (0.44)	0 (0.00)
1	2 (0.61)	1 (0.44)	1 (1.00)
2	7 (2.13)	3 (1.31)	4 (4.00)
3	319 (96.96)	224 (97.82)	95 (95.00)

Variables	Total (n=329)	Non-LVAR (n=229)	LVAR (n=100)	P
Demographics
Age (year)	58±10.8	58±10.6	58±11.5	0.944
Female [n (%)]	41 (12.46)	32 (13.97)	9 (9.00)	0.209
SBP (mmHg)	125±20	126±20	124±18	0.445
DBP (mmHg)	76±13	76±13	77±14	0.244
HR (beats/min)	79±13	79±13	79±12	0.872
BMI (kg/m²)	25.4±3.3	25.4±3.3	25.4±3.3	0.939
Killip classes				0.330
Ⅰ	254 (77.20)	182 (79.48)	72 (72.00)
Ⅱ	64 (19.45)	40 (17.47)	24 (24.00)
Ⅲ	11 (3.34)	7 (3.06)	4 (4.00)
Laboratory tests
Hb (g/L)	148.3±15.2	148.1±15.1	148.8±15.5	0.685
WBC (10⁹/L)	10.81±3.46	10.39±3.27	11.79±3.69	0.001*
Glucose (mmol/L)	8.26±3.59	8.04±3.23	8.75±4.27	0.100
Cr (µmol/L)	77.84±18.44	78.43±18.43	76.49±18.49	0.382
LDL-C (mmol/L)	3.09±0.94	3.10±0.90	3.07±1.01	0.789
TC (mmol/L)	4.60±1.12	4.63±1.11	4.54±1.14	0.515
TG (mmol/L)	1.63±0.96	1.68±1.03	1.51±0.77	0.145
NT-proBNP (pg/mL)	134.50 (51.50, 321.80)	124.00 (51.64, 251.50)	149.00 (50.72, 498.95)	0.052
Peak cTnT (ng/mL)	9.95 (4.04, 24.76)	8.22 (3.24, 21.80)	18.92 (6.53, 40.85)	<0.001*
Peak CK-MB (ng/mL)	165.80 (65.00, 257.00)	143.70 (59.79, 238.20)	216.40 (125.05, 301.50)	<0.001*
Medical history [n (%)]
Hypertension	179 (54.41)	122 (53.28)	57 (57.00)	0.533
Diabetes mellitus	81 (24.62)	57 (24.89)	24 (24.00)	0.863
Hyperlipidemia	141 (42.86)	93 (40.61)	48 (48.00)	0.213
Stroke	19 (5.78)	11 (4.80)	8 (8.00)	0.253
Current smoker	204 (62.01)	142 (62.01)	62 (62.00)	0.999
Medical therapy [n (%)]
ACEI/ARB	162 (49.24)	115 (50.22)	47 (47.00)	0.591
Beta-blocker	267 (81.16)	184 (80.35)	83 (83.00)	0.572
MRA	56 (17.02)	35 (15.28)	21 (21.00)	0.204
ARNI	167 (50.76)	114 (49.78)	53 (53.00)	0.591
SGLT2I	86 (26.14)	61 (26.64)	25 (25.00)	0.756
Antiplatelet agents	329 (100)	229 (100)	100 (100.00)	1.000
Statin	326 (99.09)	227 (99.13)	99 (99.00)	1.000
Angiographic features [n (%)]
MI location				<0.001*
Anterior MI	154 (46.81)	90 (39.30)	64 (64.00)
Non-Anterior MI	175 (53.19)	139 (60.70)	36 (36.00)
Number of diseased vessels				0.254
1	172 (52.28)	113 (49.34)	59 (59.00)
2	84 (25.53)	61 (26.64)	23 (23.00)
3	73 (22.19)	55 (24.02)	18 (18.00)
Culprit vessel				<0.001*
LAD	168 (51.06)	101 (44.10)	67 (67.00)
LCX	41 (12.46)	30 (13.10)	11 (11.00)
RCA	120 (36.47)	98 (42.79)	22 (22.00)
Number of stents				0.529
0	16 (4.86)	9 (3.93)	7 (7.00)
1	228 (69.30)	162 (70.74)	66 (66.00)
2	65 (19.76)	43 (18.78)	22 (22.00)
3	20 (6.08)	15 (6.55)	5 (5.00)
TIMI flow before PCI				0.096
0	254 (77.20)	168 (73.36)	86 (86.00)
1	12 (3.65)	10 (4.37)	2 (2.00)
2	27 (8.21)	22 (9.61)	5 (5.00)
3	36 (10.94)	29 (12.66)	7 (7.00)
TIMI flow after PCI				0.274
0	1 (0.30)	1 (0.44)	0 (0.00)
1	2 (0.61)	1 (0.44)	1 (1.00)
2	7 (2.13)	3 (1.31)	4 (4.00)
3	319 (96.96)	224 (97.82)	95 (95.00)

Variables	Total (n=329)	Non-LVAR (n=229)	LVAR (n=100)	P
LVEDV (mL)	145.05±35.60	145.78±34.57	143.37±37.98	0.572
LVESV (mL)	78.00±28.43	75.06±26.68	84.74±31.17	0.004*
LVSV (mL)	67.07±16.48	70.76±15.43	58.62±15.74	<0.001*
LVEF (%)	46.99±8.98	49.41±8.05	41.47±8.58	<0.001*
LVM (g)	115.61±26.04	113.16±25.97	121.21±25.43	0.010*
LVGLS (%)	11.19±3.24	12.24±2.90	8.77±2.60	<0.001*
LVGCS (%)	14.07±3.13	14.93±2.87	12.08±2.78	<0.001*
LVGRS (%)	22.14±6.39	23.89±6.08	18.13±5.17	<0.001*
RVEDV (mL)	113.94±29.61	116.77±30.24	107.46±27.17	0.008*
RVESV (mL)	61.54±20.58	62.22±21.13	59.98±19.28	0.364
RVSV (mL)	52.41±16.46	54.55±16.04	47.51±16.43	<0.001*
RVM (g)	26.45±5.79	26.18±6.13	27.08±4.90	0.195
RVEF (%)	46.13±9.70	47.04±9.08	44.03±10.73	0.009*
RVGLS (%)	17.68±5.51	18.72±5.10	15.29±5.71	<0.001*
RVGCS (%)	14.63±3.45	14.84±3.27	14.14±3.82	0.113
RVGRS (%)	25.32±8.59	25.45±8.26	25.01±9.34	0.670
LAV_max (mL)	65.63±20.72	66.56±20.22	63.51±21.78	0.221
LAV_pac (mL)	48.08±17.47	48.24±16.83	47.69±18.94	0.791
LAV_min (mL)	32.88±14.98	32.12±14.16	34.62±16.65	0.164
LAEF total (%)	50.76±8.34	52.63±7.26	46.50±9.10	<0.001*
LAEF passive (%)	27.30±6.15	28.03±5.75	25.61±6.72	<0.001*
LAEF active (%)	32.52±7.71	34.33±7.00	28.37±7.68	<0.001*
LATS (%)	25.56±8.90	28.06±8.30	19.83±7.51	<0.001*
LAPS (%)	13.69±5.66	14.99±5.59	10.72±4.62	<0.001*
LAAS (%)	11.86±4.42	13.06±4.15	9.11±3.74	<0.001*
RAV_max (mL)	58.50±16.73	59.90±17.05	55.29±15.56	0.021*
RAV_pac (mL)	42.33±12.37	43.03±12.54	40.74±11.89	0.123
RAV_min (mL)	29.19±9.51	29.15±9.25	29.26±10.13	0.925
RAEF total (%)	50.02±7.17	51.26±6.56	47.17±7.70	<0.001*
RAEF passive (%)	27.46±5.80	28.01±5.67	26.19±5.92	0.009*
RAEF active (%)	31.20±7.08	32.34±6.74	28.59±7.17	<0.001*
RATS (%)	28.30±11.68	31.27±10.95	21.51±10.46	<0.001*
RAPS (%)	16.24±7.69	17.94±7.34	12.35±7.06	<0.001*
RAAS (%)	12.07±5.60	13.33±5.57	9.17±4.48	<0.001*
IS (%)	23.00±11.92	19.08±10.34	31.97±10.37	<0.001*
MVO (%)	0.00 (0.00 2.95)	0.00 (0.00 0.83)	3.34 (1.43 5.82)	<0.001*
IMH [n (%)]	118 (35.87)	49 (21.40)	69 (69.00)	<0.001*

Variables	Total (n=329)	Non-LVAR (n=229)	LVAR (n=100)	P
LVEDV (mL)	145.05±35.60	145.78±34.57	143.37±37.98	0.572
LVESV (mL)	78.00±28.43	75.06±26.68	84.74±31.17	0.004*
LVSV (mL)	67.07±16.48	70.76±15.43	58.62±15.74	<0.001*
LVEF (%)	46.99±8.98	49.41±8.05	41.47±8.58	<0.001*
LVM (g)	115.61±26.04	113.16±25.97	121.21±25.43	0.010*
LVGLS (%)	11.19±3.24	12.24±2.90	8.77±2.60	<0.001*
LVGCS (%)	14.07±3.13	14.93±2.87	12.08±2.78	<0.001*
LVGRS (%)	22.14±6.39	23.89±6.08	18.13±5.17	<0.001*
RVEDV (mL)	113.94±29.61	116.77±30.24	107.46±27.17	0.008*
RVESV (mL)	61.54±20.58	62.22±21.13	59.98±19.28	0.364
RVSV (mL)	52.41±16.46	54.55±16.04	47.51±16.43	<0.001*
RVM (g)	26.45±5.79	26.18±6.13	27.08±4.90	0.195
RVEF (%)	46.13±9.70	47.04±9.08	44.03±10.73	0.009*
RVGLS (%)	17.68±5.51	18.72±5.10	15.29±5.71	<0.001*
RVGCS (%)	14.63±3.45	14.84±3.27	14.14±3.82	0.113
RVGRS (%)	25.32±8.59	25.45±8.26	25.01±9.34	0.670
LAV_max (mL)	65.63±20.72	66.56±20.22	63.51±21.78	0.221
LAV_pac (mL)	48.08±17.47	48.24±16.83	47.69±18.94	0.791
LAV_min (mL)	32.88±14.98	32.12±14.16	34.62±16.65	0.164
LAEF total (%)	50.76±8.34	52.63±7.26	46.50±9.10	<0.001*
LAEF passive (%)	27.30±6.15	28.03±5.75	25.61±6.72	<0.001*
LAEF active (%)	32.52±7.71	34.33±7.00	28.37±7.68	<0.001*
LATS (%)	25.56±8.90	28.06±8.30	19.83±7.51	<0.001*
LAPS (%)	13.69±5.66	14.99±5.59	10.72±4.62	<0.001*
LAAS (%)	11.86±4.42	13.06±4.15	9.11±3.74	<0.001*
RAV_max (mL)	58.50±16.73	59.90±17.05	55.29±15.56	0.021*
RAV_pac (mL)	42.33±12.37	43.03±12.54	40.74±11.89	0.123
RAV_min (mL)	29.19±9.51	29.15±9.25	29.26±10.13	0.925
RAEF total (%)	50.02±7.17	51.26±6.56	47.17±7.70	<0.001*
RAEF passive (%)	27.46±5.80	28.01±5.67	26.19±5.92	0.009*
RAEF active (%)	31.20±7.08	32.34±6.74	28.59±7.17	<0.001*
RATS (%)	28.30±11.68	31.27±10.95	21.51±10.46	<0.001*
RAPS (%)	16.24±7.69	17.94±7.34	12.35±7.06	<0.001*
RAAS (%)	12.07±5.60	13.33±5.57	9.17±4.48	<0.001*
IS (%)	23.00±11.92	19.08±10.34	31.97±10.37	<0.001*
MVO (%)	0.00 (0.00 2.95)	0.00 (0.00 0.83)	3.34 (1.43 5.82)	<0.001*
IMH [n (%)]	118 (35.87)	49 (21.40)	69 (69.00)	<0.001*

Variables	Total (n=329)	Training set (n=230)	Validation set (n=99)	P
Baseline data
Age (year)	58±10.8	58±10.9	57±10.8	0.423
SBP (mmHg)	125.29±19.60	125.69±19.34	124.37±20.26	0.578
DBP (mmHg)	76.26±13.45	76.67±13.27	75.31±13.88	0.402
HR (beats/min)	78.89±12.57	79.19±12.38	78.20±13.04	0.515
BMI (kg/m²)	25.38±3.30	25.26±3.12	25.64±3.68	0.369
Hb (g/L)	148.27±15.22	148.05±15.11	148.79±15.51	0.685
WBC (10⁹/L)	10.81±3.46	10.69±3.59	11.09±3.12	0.339
Glu (mmol/L)	8.26±3.59	8.44±3.72	7.83±3.23	0.155
Cr (µmol/L)	77.84±18.44	77.84±19.11	77.84±16.89	0.999
LDL-C (mmol/L)	3.09±0.94	3.04±0.95	3.19±0.91	0.175
TC (mmol/L)	4.60±1.12	4.55±1.08	4.71±1.19	0.226
TG (mmol/L)	1.63±0.96	1.63±0.97	1.64±0.93	0.940
NT-proBNP (pg/mL)	146.50(58.00, 331.70)	149.00(61.03, 343.73)	145.50(53.95, 280.15)	0.507
Peak cTnT (ng/mL)	9.98 (4.04, 24.86)	10.26 (4.34, 24.49)	7.86 (3.87, 31.57)	0.702
Peak CK-MB (ng/mL)	165.00(64.78, 256.30)	157.05(65.25, 248.52)	177.90(63.20, 267.50)	0.518
LVAR [n (%)]	100 (30.40)	71 (30.87)	29 (29.29)	0.775
Female [n (%)]	41 (12.46)	28 (12.17)	13 (13.13)	0.809
MI location [n (%)]				0.573
Non-anterior MI	175 (53.19)	120 (52.17)	55 (55.56)
Anterior MI	154 (46.81)	110 (47.83)	44 (44.44)
Hypertension [n (%)]	179 (54.41)	128 (55.65)	51 (51.52)	0.490
Diabetes [n (%)]	81 (24.62)	63 (27.39)	18 (18.18)	0.075
Hyperlipidemia [n (%)]	141 (42.86)	99 (43.04)	42 (42.42)	0.917
Stroke [n (%)]	19 (5.78)	13 (5.65)	6 (6.06)	0.884
Smoking [n (%)]	204 (62.01)	138 (60.00)	66 (66.67)	0.253
ACEI/ARB [n (%)]	162 (49.24)	113 (49.13)	49 (49.49)	0.956
Beta-blocker [n (%)]	267 (81.16)	186 (80.87)	81 (81.82)	0.847
MRA [n (%)]	56 (17.02)	39 (16.96)	17 (17.17)	0.967
ARNI [n (%)]	167 (50.76)	117 (50.87)	50 (50.51)	0.954
SGLT2I [n (%)]	86 (26.14)	60 (26.09)	26 (26.26)	0.976
Antiplatelet agents [n (%)]	329 (100)	230 (100)	99 (100)	1.000
Statin [n (%)]	326 (99.09)	228 (99.13)	98 (98.99)	0.899
Killip [n (%)]				0.411
Ⅰ	254 (77.20)	173 (75.22)	81 (81.82)
Ⅱ	64 (19.45)	49 (21.30)	15 (15.15)
Ⅲ	11 (3.34)	8 (3.48)	3 (3.03)
Number of vessels diseased [n (%)]				0.678
1	172 (52.28)	116(50.44)	56 (56.57)
2	84 (25.53)	61 (26.52)	23 (23.23)
3	73 (22.19)	53(23.04)	20 (20.20)
Culprit vessel [n (%)]				0.974
1	168 (51.06)	118 (51.30)	50 (50.51)
2	41 (12.46)	29 (12.61)	12 (12.12)
3	120 (36.47)	83 (36.09)	37 (37.37)
Number of stents [n (%)]				0.071
0	16 (4.86)	13 (5.65)	3 (3.03)
1	228 (69.30)	162 (70.43)	66 (66.67)
2	65 (19.76)	46 (20.00)	19 (19.19)
3	20 (6.08)	9 (3.91)	11 (11.11)
TIMI before PCI [n (%)]				0.083
0	254 (77.20)	182 (79.13)	72 (72.73)
1	12 (3.65)	9 (3.91)	3 (3.03)
2	27 (8.21)	13 (5.65)	14 (14.14)
3	36 (10.94)	26 (11.30)	10 (10.10)
TIMI after PCI [n (%)]				0.891
0	1 (0.30)	1 (0.43)	0 (0.00)
1	2 (0.61)	1 (0.43)	1 (1.01)
2	7 (2.13)	5 (2.17)	2 (2.02)
3	319 (96.96)	223 (96.96)	96 (96.97)
CMR parameters
LVEDV (mL)	145.05±35.60	145.84±35.60	143.20±35.72	0.538
LVESV (mL)	78.00±28.43	78.20±29.44	77.53±26.05	0.846
LVSV (mL)	67.07±16.48	67.67±16.17	65.67±17.17	0.313
LVEF (%)	46.99±8.98	47.25±9.18	46.39±8.51	0.427
LVM (g)	115.61±26.04	115.26±25.80	116.40±26.69	0.718
RVEDV (mL)	113.94±29.61	113.81±28.94	114.25±31.26	0.901
RVESV (mL)	61.54±20.58	61.17±19.88	62.41±22.19	0.616
RVSV (mL)	52.41±16.46	52.65±16.52	51.84±16.40	0.680
RVM (g)	26.45±5.79	26.23±5.52	26.97±6.39	0.283
RVEF (%)	46.19±9.51	46.41±9.63	45.70±9.25	0.536
IS (%)	23.00±11.92	22.91±11.91	23.22±12.00	0.829
LVGLS (%)	11.19±3.24	11.20±3.19	11.15±3.36	0.909
LVGCS (%)	14.07±3.13	14.18±3.11	13.80±3.18	0.312
LVGRS (%)	22.14±6.39	22.43±6.42	21.46±6.29	0.206
RVGLS (%)	17.68±5.51	17.94±5.63	17.09±5.23	0.201
RVGCS (%)	14.63±3.45	14.79±3.47	14.26±3.40	0.203
RVGRS (%)	25.15±7.41	25.46±7.64	24.45±6.82	0.255
LAV_max (mL)	65.63±20.72	66.33±21.38	64.00±19.09	0.349
LAV_pac (mL)	48.08±17.47	48.57±17.95	46.93±16.33	0.435
LAV_min (mL)	32.88±14.98	33.26±15.06	32.02±14.83	0.494
LAEF total (%)	50.76±8.34	50.73±8.53	50.85±7.91	0.907
LAEF passive (%)	27.30±6.15	27.37±6.37	27.12±5.66	0.737
LAEF active (%)	32.52±7.71	32.41±7.91	32.78±7.24	0.694
LATS (%)	25.56±8.90	25.63±8.80	25.38±9.17	0.812
LAPS (%)	13.69±5.66	13.81±5.55	13.42±5.93	0.571
LAAS (%)	11.86±4.42	11.82±4.43	11.96±4.39	0.801
RAV_max (mL)	58.50±16.73	58.98±17.22	57.38±15.54	0.428
RAV_pac (mL)	42.33±12.37	42.83±12.72	41.17±11.50	0.266
RAV_min (mL)	29.19±9.51	29.56±9.57	28.32±9.36	0.279
RAEF total (%)	50.02±7.17	49.77±7.10	50.59±7.32	0.342
RAEF passive (%)	27.46±5.80	27.22±5.65	28.01±6.13	0.256
RAEF active (%)	31.20±7.08	31.11±6.84	31.41±7.65	0.724
RATS (%)	28.30±11.68	27.90±11.48	29.23±12.16	0.345
RAPS (%)	16.24±7.69	16.06±7.43	16.67±8.29	0.509
RAAS (%)	12.07±5.60	11.85±5.69	12.57±5.35	0.281
MVO (%)	0.00 (0.00, 2.95)	0.00 (0.00, 2.98)	0.00 (0.00, 2.75)	0.701
IMH [n (%)]	119 (36.17)	81 (35.22)	38 (38.38)	0.573

急性ST段抬高型心肌梗死经皮冠状动脉介入术后左心室不良重构的新型风险预测模型：基于心脏磁共振的多中心前瞻性研究

A cardiac magnetic resonance-based risk prediction model for left ventricular adverse remodeling following percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a multi-center prospective study

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Parameter		Univariate		Multivariate
Parameter	OR	95% CI	P	OR	95% CI	P
IMH	10.50	5.33-20.69	<0.001*	2.06	0.74-5.99	0.185
IS	1.11	1.07-1.15	<0.001*	1.05	1.01-1.10	0.017
MVO	1.67	1.42-1.97	<0.001*	1.26	1.01-1.59	0.048
LVEDV	0.99	0.99-1.00	0.257
LVGLS	0.63	0.55-0.72	<0.001*	0.76	0.61-0.95	0.015
LAV_max	0.99	0.97-1.00	0.079
LVEF	0.89	0.86-0.93	<0.001*	1.04	0.97-1.12	0.248
LAAS	0.68	0.61-0.77	<0.001*	0.78	0.67-0.92	0.003
LATS	0.92	0.89-0.95	<0.001*	1.00	0.95-1.04	0.853
Peak cTnT	1.01	1.01-1.01	0.017*	1.00	0.99-1.01	0.730

Variables [n (%)]	Total (n=329)	Non-LVAR (n=229)	LVAR (n=100)	P
Cardiac death	10 (3.04)	3 (1.31)	7 (7.00)	0.016
Recurrent myocardial infarction	15 (4.56)	5 (2.18)	10 (10.00)	0.005
Rehospitalization for heart failure	35 (10.64)	10 (4.37)	25 (25.00)	<0.001
Unplanned revascularization	35 (10.64)	19 (8.30)	16 (16.00)	0.037
MACE	95 (28.88)	37 (16.16)	58 (58.00)	<0.001

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Variables	Intra-observer variability		Inter-observer variability
Variables	ICC	95% CI	ICC	95% CI
LVGLS (%)	0.988	0.964, 0.996	0.946	0.877, 0.981
LVEDV (%)	0.951	0.864, 0.983	0.932	0.851,0.974
LAAS (%)	0.942	0.838, 0.980	0.918	0.826,0.966
IS (%)	0.978	0.934, 0.993	0.902	0.801,0.959
MVO (%)	0.973	0.920, 0.991	0.943	0.849,0.981
LVEF (%)	0.961	0.903, 0.987	0.946	0.877, 0.981
ICC: Interclass correlation coefficient; CI: Confidence interval; LVGLS: Left ventricular global longitudinal strain; LVEDV: Left ventricular end-diastolic volume; LAAS: Left atrium active strain, IS: Infarct size; MVO: Microvascular obstruction; LVEF: Left ventricular ejection fraction.

Variables	Intra-observer variability		Inter-observer variability
Variables	ICC	95% CI	ICC	95% CI
LVGLS (%)	0.988	0.964, 0.996	0.946	0.877, 0.981
LVEDV (%)	0.951	0.864, 0.983	0.932	0.851,0.974
LAAS (%)	0.942	0.838, 0.980	0.918	0.826,0.966
IS (%)	0.978	0.934, 0.993	0.902	0.801,0.959
MVO (%)	0.973	0.920, 0.991	0.943	0.849,0.981
LVEF (%)	0.961	0.903, 0.987	0.946	0.877, 0.981
ICC: Interclass correlation coefficient; CI: Confidence interval; LVGLS: Left ventricular global longitudinal strain; LVEDV: Left ventricular end-diastolic volume; LAAS: Left atrium active strain, IS: Infarct size; MVO: Microvascular obstruction; LVEF: Left ventricular ejection fraction.