Circumferential Strain Predicts Major Adverse Cardiovascular Events Following an Acute ST-Segment-Elevation Myocardial Infarction
Circumferential Strain Predicts Major Adverse Cardiovascular Events Following an Acute ST-Segment-Elevation Myocardial Infarction
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DOI：
10.1148/radiol.2018181253
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发表时间：
2019-02-01
期刊：
影响因子：
19.7
通讯作者：
Berry, Colin
中科院分区：
文献类型：
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作者：
Mansion, Kenneth;Carrick, David;Berry, Colin
目的：为了研究使用心脏MRI测量的周向左心室（LV）应变预测急性ST段抬高型心肌梗死（STEMI）后主要不良心脏事件（MACE）的预后价值，材料和方法：急性STEMI患者于2011年5月11日至2012年11月22日前瞻性入组。首次住院期间，在1.5 T下进行心脏MRI。使用刺激回波位移编码（DENSE）和电影心脏MRI的特征跟踪来评估LV周向应变。结果：共有259名参与者（平均年龄，58岁6 - 11 [标准差]; 198名男性[平均年龄，58岁+/- 11]和61名女性[平均年龄，58岁+/- 12]）在STEMI后2.2天+/- 1.9天接受了心脏MRI检查。平均梗死面积为LV质量的18% +/- 13，周向应变为213% +/- 3（DENSE方法）和224% +/- 7（特征跟踪方法）。51%（259名参与者中的131名）存在微血管阻塞。在4年的中位随访期内，8%（21/259）发生了MACE。DENSE的曲线下面积（AUC）与特征跟踪的曲线下面积（AUC，0.76 vs 0.62; P = 0.03）不同。DENSE的AUC与初始梗死面积（P = 0.06）和微血管阻塞程度（P = 0.08）相似。与梗死面积相比，DENSE衍生菌株在预测MACE方面提供了增量预后获益（风险比，1.3; P
Purpose: To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI).Materials and Methods: Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations.Results: A total of 259 participants (mean age, 58 years 6 11 [standard deviation]; 198 men [mean age, 58 years +/- 11] and 61 women [mean age, 58 years +/- 12]) underwent cardiac MRI 2.2 days +/- 1.9 after STEMI. Average infarct size was 18% +/- 13 of LV mass and circumferential strain was 213% +/- 3 (DENSE method) and 224% +/- 7 (feature-tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P =.03). AUC for DENSE was similar to that of initial infarct size (P =.06) and extent of microvascular obstruction (P =.08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P