Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction
Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction
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DOI：
10.1007/s00330-018-5895-z
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发表时间：
2019-05-01
影响因子：
5.9
通讯作者：
Francone, Marco
中科院分区：
文献类型：
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作者：
Galea, Nicola;Dacquino, Gian Marco;Francone, Marco
目的探讨心肌梗死后早期心脏磁共振(CMR)对左心室射血分数(LVEF)保留的ST段抬高型心肌梗死(STEMI)患者长期危险分层的预测作用。STEMI至CMR的中位时间为5天(IQR 2~8)。检测并测量左心室体积和功能、危险面积(T2加权像)、梗死心肌(晚期增强像)、心肌内出血、早期和晚期微血管阻塞(MVO)。结果中位随访4年(3~5年)，8例(10%)患者发生MACE，年化事件发生率为2.1%。除晚期MVO的发生率(50%vs.16%；p=0.044)及其范围(2.301.64g vs.0.180.12g；p=0.000)外，MACE患者与非MACE患者的CMR组织标志物差异均无统计学意义。从受试者-操作特征曲线(曲线下面积0.89；95%可信区间0.75-1.0；p=0.000)来看，晚期MVO范围和GT；0.385 g是长期MACE的独立预测因子(敏感性=87%，特异度=90%；风险比=2.24；95%可信区间，1.5-3.33；p=0.000)。值得注意的是，晚期MVO范围和0.385G提供了相关的预后洞察力，从而改善了长期风险分层。心脏磁共振提供的关键点中心点组织标记物有助于心肌梗死后的预后分层p id=Par6中心点急性心肌梗死后晚期微血管阻塞的发生增加了5年后主要不良事件的风险。Pid=Par7中心点晚期Gd增强图像上的微血管阻塞程度越大，心肌梗死患者不良事件的风险增加，且左心功能得到保护。
ObjectivesTo investigate the prognostic role of early post-infarction cardiac magnetic resonance (CMR) on long-term risk stratification of ST segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF).MethodsSeventy-seven STEMI patients treated by primary percutaneous coronary intervention (PCI) and LVEF >50% at CMR were included. The median time between STEMI and CMR was 5days (IQR 2-8). LV volumes and function, area at risk (on T2 weighted images), infarcted myocardium (on late enhanced images), intramyocardial hemorrhage, and early and late microvascular obstruction (MVO) were detected and measured. CMR tissue determinants were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up.ResultsDuring median follow-up of 4years (range 3 to 5years), eight (10%) patients experienced MACE, yielding an annualized event rate of 2.1%. All CMR tissue markers were not significantly different between MACE and no-MACE patients, except for the presence of late MVO (50% vs. 16%, respectively; p=0.044) and its extent (2.301.64g vs. 0.180.12g, respectively; p=0.000). From receiver-operating characteristic (ROC) curve (area under the curve 0.89; 95% confidence interval, 0.75-1.0; p=0.000), late MVO extent >0.385g was a strong independent predictor of MACE at long-term follow-up (sensitivity=87%, specificity=90%; hazard ratio=2.24; 95% confidence interval, 1.51-3.33; p=0.000).ConclusionsLate MVO extent after primary PCI on CMR seems to be a strong predictor of MACE at 5-year follow-up in patients with LVEF >50%. Noticeably, late MVO extent >0.385g provided relevant prognostic insights leading to improved long-term risk stratification.Key Points center dot Tissue markers provided by cardiac magnetic resonance aid in prognostic stratification after myocardial infarction p id=Par6 center dot The occurrence of late microvascular obstruction after acute myocardial infarction increases risk of major adverse events at 5-year follow-up.p id=Par7 center dot The greater microvascular obstruction extent on late gadolinium enhanced images is related to an increased risk of adverse events in patients with myocardial infarction and preserved left ventricular function.