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

doi:10.12122/j.issn.1673-4254.2025.04.01

Abstract

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

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.

Figures/Tables 14

References 50

1	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2100-32.
2	Vogel B, Claessen BE, Arnold SV, et al. ST-segment elevation myocardial infarction[J]. Nat Rev Dis Primers, 2019, 5(1): 39.
3	Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes[J]. Eur Heart J, 2023, 44(38): 3720-826.
4	Bulluck H, Dharmakumar R, Arai AE, et al. Cardiovascular magnetic resonance in acute ST-segment-elevation myocardial infarction: recent advances, controversies, and future directions[J]. Circulation, 2018, 137(18): 1949-64.
5	Berezin AE, Berezin AA. Adverse cardiac remodelling after acute myocardial infarction: old and new biomarkers[J]. Dis Markers, 2020, 2020: 1215802.
6	Frantz S, Hundertmark MJ, Schulz-Menger J, et al. Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies[J]. Eur Heart J, 2022, 43(27): 2549-61.
7	Calvieri C, Riva A, Sturla F, et al. Left ventricular adverse remodeling in ischemic heart disease: emerging cardiac magnetic resonance imaging biomarkers[J]. J Clin Med, 2023, 12(1): 334.
8	Del Buono MG, Moroni F, Montone RA, et al. Ischemic cardiomyopathy and heart failure after acute myocardial infarction[J]. Curr Cardiol Rep, 2022, 24(10): 1505-15.
9	A X, Liu M, Chen T, et al. Non-contrast cine cardiac magnetic resonance derived-radiomics for the prediction of left ventricular adverse remodeling in patients with ST-segment elevation myocardial infarction[J]. Korean J Radiol, 2023, 24(9): 827-37.
10	Reindl M, Tiller C, Holzknecht M, et al. Global longitudinal strain by feature tracking for optimized prediction of adverse remodeling after ST-elevation myocardial infarction[J]. Clin Res Cardiol, 2021, 110(1): 61-71.
11	Cui JN, Zhao YN, Qian G, et al. Cardiac magnetic resonance for the early prediction of reverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction[J]. Eur Radiol, 2023, 33(12): 8501-12.
12	Holmes AA, Romero J, Levsky JM, et al. Circumferential strain acquired by CMR early after acute myocardial infarction adds inc-remental predictive value to late gadolinium enhancement imaging to predict late myocardial remodeling and subsequent risk of sudden cardiac death[J]. J Interv Card Electrophysiol, 2017, 50(3): 211-8.
13	Pascaud A, Assunção A Jr, Garcia G, et al. Left atrial remodeling following ST-segment-elevation myocardial infarction correlates with infarct size and age older than 70 Years[J]. J Am Heart Assoc, 2023, 12(6): e026048.
14	Darweesh RM, Ahmed DMY, Ahmed KM, et al. Evaluation of right ventricular functions in patients with ischemic cardiomyopathy by speckle-tracking echocardiography[J]. Egypt Heart J, 2024, 76(1): 132.
15	Chimed S, van der Bijl P, de Paula Lustosa R, et al. Prognostic relevance of right ventricular remodeling after ST-segment elevation myocardial infarction in patients treated with primary percutaneous coronary intervention[J]. Am J Cardiol, 2022, 170: 1-9.
16	Chinese Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. 2019 Chinese Society of Cardiology (CSC) guidelines for the diagnosis and man-agement of patients with ST-segment elevation myocardial infarction[J]. Zhonghua Xin Xue Guan Bing Za Zhi, 2019, 47(10): 766-83.
17	Wang L, Liu T, Wang C, et al. Development and validation of a predictive model for adverse left ventricular remodeling in NSTEMI patients after primary percutaneous coronary intervention[J]. BMC Cardiovasc Disord, 2022, 22(1): 386.
18	Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2018, 39(2): 119-77.
19	Bulluck H, Carberry J, Carrick D, et al. Redefining adverse and reverse left ventricular remodeling by cardiovascular magnetic resonance following ST-segment-elevation myocardial infarction and their implications on long-term prognosis[J]. Circ Cardiovasc Imaging, 2020, 13(7): e009937.
20	Legallois D, Hodzic A, Alexandre J, et al. Definition of left ventricular remodelling following ST-elevation myocardial infarction: a systematic review of cardiac magnetic resonance studies in the past decade[J]. Heart Fail Rev, 2022, 27(1): 37-48.
21	He J, Yang WJ, Wu WC, et al. Clinical features, myocardial strain and tissue characteristics of heart failure with preserved ejection fraction in patients with obesity: a prospective cohort study[J]. eClinicalMedicine, 2023, 55: 101723.
22	Kramer CM, Barkhausen J, Bucciarelli-Ducci C, et al. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update[J]. J Cardiovasc Magn Reson, 2020, 22(1): 17.
23	Peters DC, Lamy J, Sinusas AJ, et al. Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers[J]. Eur Heart J Cardiovasc Imaging, 2021, 23(1): 14-30.
24	Olsen FJ, Bertelsen L, de Knegt MC, et al. Multimodality cardiac imaging for the assessment of left atrial function and the association with atrial arrhythmias[J]. Circ Cardiovasc Imaging, 2016, 9(10): e004947.
25	Kowallick JT, Morton G, Lamata P, et al. Quantification of atrial dynamics using cardiovascular magnetic resonance: inter-study reproducibility[J]. J Cardiovasc Magn Reson, 2015, 17(1): 36.
26	van Kranenburg M, Magro M, Thiele H, et al. Prognostic value of microvascular obstruction and infarct size, as measured by CMR in STEMI patients[J]. JACC Cardiovasc Imag, 2014, 7(9): 930-9.
27	Durante A, Laricchia A, Benedetti G, et al. Identification of high-risk patients after ST-segment-elevation myocardial infarction: comparison between angiographic and magnetic resonance parameters[J]. Circ Cardiovasc Imaging, 2017, 10(6): e005841.
28	Betgem RP, de Waard GA, Nijveldt R, et al. Intramyocardial haemorrhage after acute myocardial infarction[J]. Nat Rev Cardiol, 2015, 12(3): 156-67.
29	中国医师协会胸痛专业委员会, 中华心血管病杂志（网络版）编辑委员会, 急性心肌梗死后心室重构防治专家共识起草组. 急性心肌梗死后心室重构防治专家共识[J]. 中华心血管病杂志（网络版）, 2020,3(1): 1-7.
30	Leancă SA, Crișu D, Petriș AO, et al. Left ventricular remodeling after myocardial infarction: from physiopathology to treatment[J]. Life: Basel, 2022, 12(8): 1111.
31	Oleynikov V, Salyamova L, Kvasova O, et al. Prediction of adverse post-infarction left ventricular remodeling using a multivariate regression model[J]. Diagnostics: Basel, 2022, 12(3): 770.
32	Haberka M, Starzak M, Smolka G, et al. Echocardiography and cardiac magnetic resonance in the assessment of left-ventricle remodeling: differences implying clinical decision[J]. J Clin Med, 2024, 13(6): 1620.
33	Masci PG, Ganame J, Francone M, et al. Relationship between location and size of myocardial infarction and their reciprocal influences on post-infarction left ventricular remodelling[J]. Eur Heart J, 2011, 32(13): 1640-8.
34	Lombardo A, Niccoli G, Natale L, et al. Impact of microvascular obstruction and infarct size on left ventricular remodeling in reperfused myocardial infarction: a contrast-enhanced cardiac magnetic resonance imaging study[J]. Int J Cardiovasc Imag, 2012, 28(4): 835-42.
35	Heusch G. Coronary microvascular obstruction: the new frontier in cardioprotection[J]. Basic Res Cardiol, 2019, 114(6): 45.
36	Rios-Navarro C, Marcos-Garces V, Bayes-Genis A, et al. Microvascular obstruction in ST-segment elevation myocardial infarction: looking back to move forward. focus on CMR[J]. J Clin Med, 2019, 8(11): E1805.
37	Ndrepepa G, Colleran R, Kastrati A. No-reflow after percutaneous coronary intervention: a correlate of poor outcome in both persistent and transient forms[J]. EuroIntervention, 2018, 14(2): 139-41.
38	Niccoli G, Scalone G, Lerman A, et al. Coronary microvascular obstruction in acute myocardial infarction[J]. Eur Heart J, 2016, 37(13): 1024-33.
39	Konijnenberg LSF, Damman P, Duncker DJ, et al. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction[J]. Cardiovasc Res, 2020, 116(4): 787-805.
40	Dobrovie M, Barreiro-Pérez M, Curione D, et al. Inter-vendor reproducibility and accuracy of segmental left ventricular strain measurements using CMR feature tracking[J]. Eur Radiol, 2019, 29(12): 6846-57.
41	Ben Driss A, Ben Driss Lepage C, Sfaxi A, et al. Strain predicts left ventricular functional recovery after acute myocardial infarction with systolic dysfunction[J]. Int J Cardiol, 2020, 307: 1-7.
42	Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction[J]. Lancet, 2017, 389(10065): 197-210.
43	Rajiah PS, Kalisz K, Broncano J, et al. Myocardial strain evaluation with cardiovascular MRI: physics, principles, and clinical applications[J]. Radiographics, 2022, 42(4): 968-90.
44	Panovsky R, Pleva M, Feitova V, et al. Left atrium assessment: the evolving role of MRI[J]. J Cardiovasc Med: Hagerstown, 2015, 16(10): 671-80.
45	Spencer L, Wright L, Foulkes SJ, et al. Characterizing the influence of cardiorespiratory fitness on left atrial size and function in the general population[J]. Am J Physiol Heart Circ Physiol, 2024, 326(5): H1269-78.
46	Modin D, Biering-Sørensen SR, Møgelvang R, et al. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(7): 804-15.
47	Leng S, Ge H, He J, et al. Long-term prognostic value of cardiac MRI left atrial strain in ST-segment elevation myocardial infarction[J]. Radiology, 2020, 296(2): 299-309.
48	Chu AA, Wu TT, Zhang L, et al. The prognostic value of left atrial and left ventricular strain in patients after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention[J]. Cardiol J, 2021, 28(5): 678-89.
49	Legallois D, Hodzic A, Milliez P, et al. Left atrial strain quantified after myocardial infarction is associated with early left ventricular remodeling[J]. Echocardiography, 2022, 39(12): 1581-8.
50	El-Naggar HM, Osman AS, Ahmed MA, et al. Three-dimensional echocardiographic assessment of left ventricular geometric changes following acute myocardial infarction[J]. Int J Cardiovasc Imag, 2023, 39(3): 607-20.

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