背景:心肌应变可以分析心肌梗死(MI)后的早期心肌功能障碍。然而,通过心脏磁共振(CMR)成像获得的左心室(LV)应变(包括局部和整体应变)与ST段抬高型心肌梗死(STEMI)后左心室血栓(LVT)之间的相关性尚不清楚.
方法:回顾性临床观察研究包括在STEMI后两周内接受CMR的LVT(n=20)和非LVT(n=195)患者。CMR图像使用CVI42(环形心血管成像,加拿大)获得LV应变值。Logistic回归分析确定了基线特征中LVT的危险因素,CMR心室应变,左心室射血分数(LVEF)。考虑到菌株之间的潜在相关性,使用9种不同的模型评估了LV菌株识别LVT的能力。使用GraphPadPrism生成接收器工作特性曲线,LVEF曲线下面积(AUC),根尖纵向应变(LS),计算周向应变(CS)以确定其区分LVT的能力。
结果:在215名患者中,开发的LVT为9.3%,在前MI患者中发病率为14.5%。单因素回归显示LAD梗死相关动脉的关联,较低的NT-proBNP,较低的LVEF,减少全球,中室,和顶端应变与LVT。进一步的多元回归分析表明,根尖LS,LVEF和NT-proBNP仍与LVT独立相关(心尖LS:OR=1.14,95CI(1.01,1.30),P=0.042;LVEF:OR=0.91,95CI(0.85,0.97),P=0.005;NT-proBNP:OR=2.35,95CI(1.04,5.31))。
结论:STEMI后CMR根尖LS降低与LVT独立相关。
BACKGROUND: Myocardial strain can analyze early myocardial dysfunction after myocardial infarction (MI). However, the correlation between left ventricular (LV) strain (including regional and global strain) obtained by cardiac magnetic resonance (CMR) imaging and left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) is unclear.
METHODS: The retrospective clinical observation study included patients with LVT (n = 20) and non-LVT (n = 195) who underwent CMR within two weeks after STEMI. CMR images were analyzed using CVI 42 (Circle Cardiovascular Imaging, Canada) to obtain LV strain values. Logistic regression analysis identified risk factors for LVT among baseline characteristics, CMR ventricular strain, and left ventricular ejection fraction (LVEF). Considering potential correlations between strains, the ability of LV strain to identify LVT was evaluated using 9 distinct models. Receiver operating characteristic curves were generated with GraphPad Prism, and the area under the curve (AUC) of LVEF, apical longitudinal strain (LS), and circumferential strain (CS) was calculated to determine their capacity to distinguish LVT.
RESULTS: Among 215 patients, 9.3% developed LVT, with a 14.5% incidence in those with anterior MI. Univariate regression indicated associations of LAD infarct-related artery, lower NT-proBNP, lower LVEF, and reduced global, midventricular, and apical strain with LVT. Further multivariable regression analysis showed that apical LS, LVEF and NT-proBNP were still independently related to LVT (Apical LS: OR = 1.14, 95%CI (1.01, 1.30), P = 0.042; LVEF: OR = 0.91, 95%CI (0.85, 0.97), P = 0.005; NT-proBNP: OR = 2.35, 95%CI (1.04, 5.31) ).
CONCLUSIONS: Reduced apical LS on CMR is independently associated with LVT after STEMI.