Objective: To evaluate the predictive value of a multiparametric cardiac magnetic resonance (CMR) approach for ventricular remodeling in ST-segment-elevation myocardial infarction (STEMI) patients with mildly reduced or preserved left ventricular ejection fraction (LVEF). Methods: This study is a prospective cohort study. STEMI patients with acute LVEF>40% after primary percutaneous coronary intervention (PCI) in Beijing Anzhen Hospital from October 2019 to September 2021 were enrolled. All patients received acute (3-7 days) and follow-up (3 months) CMR post-PCI. According to absence or presence of ventricular remodeling, patients were divided into ventricular remodeling group and non-ventricular remodeling group. Basic clinical characteristics and CMR indicators were analyzed and compared between the two groups. Logistic regression and receiver operating characteristic (ROC) curves were used to explore the predictive performance of CMR high-risk attributes for ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF. The predictive value of combining multiple high-risk characteristics of CMR for ventricular remodeling was analyzed and compared with the traditional clinical risk factor model. Results: A total of 123 STEMI patients were enrolled (aged (57.1±11.1) years, 102 (82.9%) males). There were 97 cases (78.9%) patients in the non-ventricular remodeling group and 26 cases (21.1%) in the ventricular remodeling group. After adjustment for clinical risk factors, stroke volume<51.6 ml, global circumferential strain>-13.7%, infarct size>39.2%, microvascular obstruction>0.5%, and myocardial salvage index<43.9 were independently associated with ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF. The incidence of ventricular remodeling increased with the increasing number of CMR high-risk attributes (P<0.01). The number of CMR high-risk attributes ≥3 was an independent predictor of adverse remodeling (adjusted OR=5.95, 95 CI%: 2.25-15.72, P<0.01) in STEMI patients with mildly reduced or preserved LVEF. Furthermore, the number of CMR high-risk attributes had incremental predictive value over baseline clinical risk factors (area under curve: 0.843 vs. 0.696, P<0.01). Conclusions: In STEMI patients with mild reduced or preserved LVEF, 5 CMR characteristics are associated with ventricular remodeling. The combination of ≥3 CMR high-risk characteristics is an independent predictor of ventricular remodeling, which has incremental predictive value beyond traditional risk factors in this patient cohort.
目的： 探讨联合多个心脏磁共振（CMR）高危特征对左心室射血分数（LVEF）轻度降低或保留的ST段抬高型心肌梗死（STEMI）患者心室重构的预测价值。 方法： 本研究为前瞻性队列研究。选取2019年10月至2021年9月于北京安贞医院接受直接经皮冠状动脉介入治疗（PCI）后，急性期LVEF>40%的STEMI患者。所有患者完成急性期（术后3~7 d）及恢复期（术后3个月）2次CMR检查。按照是否发生心室重构，将患者分为心室重构组和无心室重构组。收集并比较两组患者的基本临床特征和CMR指标，采用logistic回归和受试者工作特征（ROC）曲线进行分析，筛选出预测心室重构的CMR高危特征。分析联合多个CMR高危特征对LVEF轻度降低或保留的STEMI患者心室重构的预测价值，并与传统临床危险因素模型进行比较。 结果： 共纳入123例STEMI患者，年龄（57.1±11.1）岁，男性102例（82.9%），无心室重构组97例（78.9%），心室重构组26例（21.1%）。多因素logistic回归筛选出心室重构的5个CMR高危特征：每搏输出量（SV）<51.6 ml、整体周向应变（GCS）>-13.7%、梗死面积>39.2%、微循环障碍（MVO）>0.5%以及心肌挽救指数（MSI）<43.9。STEMI患者CMR高危特征的个数越多，则心室重构的发生率越高（P<0.01）。合并≥3个CMR高危特征是LVEF轻度降低或保留的STEMI患者发生心室重构的独立预测因素（OR=5.95，95%CI：2.25~15.72，P<0.01）。与传统临床危险因素模型相比，结合CMR高危特征个数能够提供增量预测价值（曲线下面积0.843比0.696，P<0.01）。 结论： 在LVEF轻度降低或保留的STEMI患者中，5项CMR特征与心室重构发生相关，合并≥3个CMR高危特征是心室重构的独立预测因素，其具有传统危险因素以外的增量预测价值。.