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Abstract：
OBJECTIVE: To evaluate the predictive value of global longitudinal strain (GLS) measured by cardiac magnetic resonance (CMR) feature-tracking technique for left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).
METHODS: A total of 403 patients undergoing PCI for acute STEMI were prospectively recruited from multiple centers in China.CMR examinations were performed one week (7±2 days) and 6 months after myocardial infarction to obtain GLS, global radial strain (GRS), global circumferential strain (GCS), ejection fraction (LVEF) and infarct size (IS).The primary endpoint was LVR, defined as an increase of left ventricle end-diastolic volume by ≥20% or an increase of left ventricle end-systolic volume by ≥15% from the baseline determined by CMR at 6 months.Logistic regression analysis was performed to evaluate the predictive value of CMR parameters for LVR.
RESULTS: LVR occurred in 101 of the patients at 6 months after myocardial infarction.Compared with those without LVR (n=302), the patients in LVR group exhibited significantly higher GLS and GCS (P < 0.001) and lower GRS and LVEF (P < 0.001).Logistic regression analysis indicated that both GLS (OR=1.387, 95%CI: 1.223-1.573;P < 0.001) and LVEF (OR=0.951, 95%CI: 0.914-0.990;P=0.015) were independent predictors of LVR.ROC curve analysis showed that at the optimal cutoff value of-10.6%, GLS had a sensitivity of 74.3% and a specificity of 71.9% for predicting LVR.The AUC of GLS was similar to that of LVEF for predicting LVR (P=0.146), but was significantly greater than those of other parameters such as GCS, GRS and IS (P < 0.05);the AUC of LVEF did not differ significantly from those of the other parameters (P>0.05).
CONCLUSIONS: In patients receiving PCI for STEMI, GLS measured by CMR is a significant predictor of LVR occurrence with better performance than GRS, GCS, IS and LVEF.
METHODS: A total of 403 patients undergoing PCI for acute STEMI were prospectively recruited from multiple centers in China.CMR examinations were performed one week (7±2 days) and 6 months after myocardial infarction to obtain GLS, global radial strain (GRS), global circumferential strain (GCS), ejection fraction (LVEF) and infarct size (IS).The primary endpoint was LVR, defined as an increase of left ventricle end-diastolic volume by ≥20% or an increase of left ventricle end-systolic volume by ≥15% from the baseline determined by CMR at 6 months.Logistic regression analysis was performed to evaluate the predictive value of CMR parameters for LVR.
RESULTS: LVR occurred in 101 of the patients at 6 months after myocardial infarction.Compared with those without LVR (n=302), the patients in LVR group exhibited significantly higher GLS and GCS (P < 0.001) and lower GRS and LVEF (P < 0.001).Logistic regression analysis indicated that both GLS (OR=1.387, 95%CI: 1.223-1.573;P < 0.001) and LVEF (OR=0.951, 95%CI: 0.914-0.990;P=0.015) were independent predictors of LVR.ROC curve analysis showed that at the optimal cutoff value of-10.6%, GLS had a sensitivity of 74.3% and a specificity of 71.9% for predicting LVR.The AUC of GLS was similar to that of LVEF for predicting LVR (P=0.146), but was significantly greater than those of other parameters such as GCS, GRS and IS (P < 0.05);the AUC of LVEF did not differ significantly from those of the other parameters (P>0.05).
CONCLUSIONS: In patients receiving PCI for STEMI, GLS measured by CMR is a significant predictor of LVR occurrence with better performance than GRS, GCS, IS and LVEF.
摘要：
目的：评价心脏磁共振(CMR)特征跟踪技术测量的整体纵向应变(GLS)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后左心室重构(LVR)的预测价值。
方法：从中国多个中心前瞻性招募了403例急性STEMIPCI患者。心肌梗死后1周（7±2天）和6个月进行CMR检查以获得GLS，全局径向应变(GRS),全局周向应变(GCS)，射血分数（LVEF）和梗死面积（IS）。主要终点是LVR，定义为在6个月时,左心室舒张末期容积从CMR确定的基线增加≥20%或左心室收缩末期容积增加≥15%.采用Logistic回归分析评价CMR参数对LVR的预测价值。
结果：101例患者在心肌梗死后6个月发生了LVR。与没有LVR的(n=302)相比，LVR组患者GLS和GCS显著升高(P<0.001),GRS和LVEF显著降低(P<0.001)。Logistic回归分析显示GLS(OR=1.387,95CI:1.223~1.573;P<0.001)和LVEF(OR=0.951,95CI:0.914~0.990;P=0.015)是LVR的独立预测因子。ROC曲线分析表明,在最佳截止值为-10.6%时,GLS预测LVR的敏感性为74.3%，特异性为71.9%。GLS预测LVR的AUC与LVEF相似(P=0.146),但明显大于GCS等其他参数，GRS和IS（P<0.05）；LVEF的AUC与其他参数无明显差异（P>0.05）。
结论：在接受PCI治疗的STEMI患者中，CMR测量的GLS是LVR发生的重要预测因子，性能优于GRS，GCS,IS和LVEF。
方法：从中国多个中心前瞻性招募了403例急性STEMIPCI患者。心肌梗死后1周（7±2天）和6个月进行CMR检查以获得GLS，全局径向应变(GRS),全局周向应变(GCS)，射血分数（LVEF）和梗死面积（IS）。主要终点是LVR，定义为在6个月时,左心室舒张末期容积从CMR确定的基线增加≥20%或左心室收缩末期容积增加≥15%.采用Logistic回归分析评价CMR参数对LVR的预测价值。
结果：101例患者在心肌梗死后6个月发生了LVR。与没有LVR的(n=302)相比，LVR组患者GLS和GCS显著升高(P<0.001),GRS和LVEF显著降低(P<0.001)。Logistic回归分析显示GLS(OR=1.387,95CI:1.223~1.573;P<0.001)和LVEF(OR=0.951,95CI:0.914~0.990;P=0.015)是LVR的独立预测因子。ROC曲线分析表明,在最佳截止值为-10.6%时,GLS预测LVR的敏感性为74.3%，特异性为71.9%。GLS预测LVR的AUC与LVEF相似(P=0.146),但明显大于GCS等其他参数，GRS和IS（P<0.05）；LVEF的AUC与其他参数无明显差异（P>0.05）。
结论：在接受PCI治疗的STEMI患者中，CMR测量的GLS是LVR发生的重要预测因子，性能优于GRS，GCS,IS和LVEF。
