摘要
目的 探讨心脏磁共振特征追踪(cardiac magnetic resonance feature tracking, CMR-FT)技术在急性心肌梗死(acute myocardial infarction, AMI)介入术后院内主要心血管不良事件(major adverse cardiovascular events, MACE)中的预后价值。材料与方法 招募自2019年01月至2022年11月收治的300例AMI患者为研究对象,根据是否发生MACE分为两组,即MACE组(n=79)和对照组(n=221)。两组患者均在发病12 h内行经皮冠状动脉介入术(percutaneous coronary intervention, PCI),术后48~72 h行CMR检查,同时监测住院2周内MACE。比较两组基线资料和心肌应力参数,通过Cox回归分析心肌应变力参数中AMI介入术后院内MACE的独立预测因子,并绘制受试者工作特征曲线评估心肌应变力参数的诊断效能。结果 通过多因素Cox回归分析发现,心脏MRI应变力参数中左室整体纵向应变(global longitudinal strain, GLS)、左室整体周向应变(global circumferential strain, GCS)是AMI介入术后院内MACE的独立预测因子,风险比(hazard ratio, HR)分别为1.24 [95%置信区间(confidence interval, CI):1.09~1.37]、1.17(95%CI:1.08~1.22),P均<0.001;其中GLS诊断效能最佳,曲线下面积(area under the curve, AUC)为0.882(95%CI:0.706~0.991),GLS临界值选取-11.9%,当GLS<-11.9%时(小于其绝对值),MACE发生率明显增加,敏感度为89%,特异度为82%,约登指数为0.80;GCS诊断效能次之,AUC为0.735(95%CI:0.631~0.958),GCS临界值选取-17.8%,当GCS<-17.8%时(小于其绝对值),MACE发生率明显增加,敏感度为78%,特异度为65%,约登指数为0.75。Kaplan-Meier曲线分析发现,GLS<-11.9%患者总生存率低于GLS≥-11.9%患者(P<0.05),GCS<-17.8%患者总生存率低于GCS≥-17.8%患者(P<0.05)。结论 CMR-FT技术对AMI患者PCI术后院内MACE具有较高的预后价值,可辅助临床早期预测和防治心肌梗死后院内MACE的发生,改善心肌梗死患者近期预后。
Objective:To investigate the prognostic value of cardiac magnetic resonance feature tracking(CMR-FT)technique in major cardiovascular adverse events(MACE)in hospital after interventional therapy for acute myocardial infarction(AMI).Materials and Methods:Three hundred patients with AMI admitted from January 2019 to October 2022 were selected as study subjects.They were divided into two groups according to whether MACE occurred,namely,MACE group(n=79)and control group(n=221,non MACE group).Both groups of patients underwent percutaneous coronary intervention(PCI)within 12 hours of onset,and CMR was performed 48-72 hours after operation.At the same time,MACE were monitored within 2 weeks of hospitalization.The baseline data and myocardial strain parameters of the two groups were compared.The independent predictors of MACE in the hospital after intervention therapy for AMI were analyzed by Cox regression,and the diagnostic efficacy of myocardial strain parameters was evaluated by drawing the subject's working characteristic curve.Results:Cox regression analysis showed that the left ventricular global longitudinal strain[GLS,hazard ratio(HR):1.24,95%confidence interval(CI):1.09-1.37,P<0.001]and the left ventricular global circumferential strain(GCS,HR:1.17,95%CI:1.08-1.22,P<0.001)were independent predictors of adverse cardiovascular events after percutaneous coronary intervention in patients with AMI.The diagnostic efficacy of GLS was the best,area under the curve(AUC)was 0.882(95%CI:0.706-0.991),and the cut-off value of GLS was-11.9%.When GLS<-11.9%(less than its absolute value),the incidence of MACE was significantly increased,with sensitivity of 89%,specificity of 82%,and Youden index of 0.80.The diagnostic efficacy of GCS was the second,AUC was 0.735(95%CI:0.631-0.958),and the cut-off value of GCS was-17.8%.When GCS<-17.8%(less than its absolute value),the incidence of MACE was significantly increased,with sensitivity of 78%,specificity of 65%,and Youden index of 0.75.Kaplan-Meier curve analysis showed that the overall survival rate of patients with GLS<-11.9%was lower than that of patients with GLS≥-11.9%(P<0.05),and the overall survival rate of patients with GCS<-17.8%was lower than that of patients with GCS≥-17.8%(P<0.05).Conclusions:CMR-FT technique has a high prognostic value for MACE in the hospital after PCI in AMI,it can assist in early clinical prediction and prevention of MACE during hospitalization after myocardial infarction,and improve the short-term prognosis of patients with myocardial infarction.
作者
张宇
卢璐
徐俊伟
郑勇强
于小利
殷常青
王治
ZHANG Yu;LU Lu;XU Junwei;ZHENG Yongqiang;YU Xiaoli;YIN Changqing;WANG Zhi(Department of Radiology,the Affiliated Jiangyin Hospital of Nantong University,Jiangyin People's Hospital,Wuxi 214431,China;Department of Radiology,Jiangsu Province Hospital of Chinese Medicine,the Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210004,China;Department of Cardiology,the Affiliated Brain Hospital of Nanjing Medical University,Nanjing Chest Hospital,Nanjing 210029,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2023年第5期123-131,共9页
Chinese Journal of Magnetic Resonance Imaging
基金
国家自然科学基金面上项目(编号:81570365)
南京医科大学科技发展基金一般项目(编号:NMUB2020229)。
关键词
冠心病
急性心肌梗死
心血管不良事件
磁共振成像
特征追踪技术
疗效预测
coronary heart disease
acute myocardial infarction
major adverse cardiovascular events
magnetic resonance imaging
feature tracking technique
efficacy prediction
作者简介
通信作者:徐俊伟,E-mail:christxjw@163.com。
