目的:急性ST段抬高型心肌梗死(STEMI)患者心室小梁复杂性的时间演变及其与主要不良心血管事件(MACE)的相关性仍不确定。
方法:这项回顾性分析纳入了接受急性STEMI直接经皮冠状动脉介入治疗(pPCI)的患者,在急性(7天内)拥有心脏磁共振(CMR)数据,亚急性(pPCI术后1个月),和慢性期(pPCI后6个月),从2015年1月至2020年1月在三个参与站点。测量了全局的分形维数(FD),梗塞,和每个阶段左心室小梁的远端区域。使用多变量Cox回归分析FD与MACE的潜在关联。
结果:在200名接受分析的患者中(182名男性;中位年龄,61岁;年龄范围,50-66岁),37例(18.5%)在31.2个月的中位随访期间遇到MACE。FD表现出逐渐下降(急性时的全球FD,亚急性,慢性期:1.253±0.049,1.239±0.046,1.230±0.045,p<0.0001),在随后经历MACE的患者中观察到更明显的下降(p<0.001)。亚急性期的整体FD与MACE相关(危险比0.89(0.82,0.97),p=0.01),全球FD值低于1.26与风险增加相关。
结论:在STEMI后的患者中,全球FD,作为左心室小梁复杂性的指标,独立证明与随后的主要不良心血管事件有关,除了包括左心室射血分数的因素,左心室舒张末期容积指数,梗死面积,心率,NYHA类,和pPCI后TIMI流。
■在患有ST段抬高型心肌梗死的患者中,全局分形维数,作为左心室小梁复杂性的量度,提供了与随后的主要不良心血管事件的独立关联。
结论:•STEMI后全球和地区FD下降,在随后的MACE患者中更是如此。•除临床和CMR因素外,亚急性期较低的整体FD和急性至亚急性期的Δ整体FD与随后的MACE相关。•亚急性期的整体FD与MACE独立相关,整体FD值低于1.26与更高的风险相关。
OBJECTIVE: The temporal evolution of ventricular trabecular complexity and its correlation with major adverse cardiovascular events (MACE) remain indeterminate in patients presenting with acute ST elevation myocardial infarction (STEMI).
METHODS: This retrospective analysis enrolled patients undergoing primary percutaneous coronary intervention (pPCI) for acute STEMI, possessing cardiac magnetic resonance (CMR) data in the acute (within 7 days), subacute (1 month after pPCI), and chronic phases (6 months after pPCI) from January 2015 to January 2020 at the three participating sites. Fractal dimensions (FD) were measured for the global, infarct, and remote regions of left ventricular trabeculae during each phase. The potential association of FD with MACE was analyzed using multivariate Cox regression.
RESULTS: Among the 200 analyzed patients (182 men; median age, 61 years; age range, 50-66 years), 37 (18.5%) encountered MACE during a median follow-up of 31.2 months. FD exhibited a gradual decrement (global FD at acute, subacute, and chronic phases: 1.253 ± 0.049, 1.239 ± 0.046, 1.230 ± 0.045, p < 0.0001), with a more pronounced decrease observed in patients subsequently experiencing MACE (p < 0.001). The global FD at the subacute phase correlated with MACE (hazard ratio 0.89 (0.82, 0.97), p = 0.01), and a global FD value below 1.26 was associated with a heightened risk.
CONCLUSIONS: In patients post-STEMI, the global FD, serving as an indicator of left ventricular trabeculae complexity, independently demonstrated an association with subsequent major adverse cardiovascular events, beyond factors encompassing left ventricular ejection fraction, indexed left ventricular end-diastolic volume, infarct size, heart rate, NYHA class, and post-pPCI TIMI flow.
UNASSIGNED: In patients who have had an ST-segment elevation myocardial infarction, global fractal dimension, as a measure of left ventricular trabeculae complexity, provided independent association with subsequent major adverse cardiovascular event.
CONCLUSIONS: • Global and regional FD decreased after STEMI, and more so in patients with subsequent MACE. • Lower global FD at the subacute phase and Δglobal FD from acute to subacute phase were associated with subsequent MACE besides clinical and CMR factors. • Global FD at the subacute phase independently correlated with MACE and global FD value below 1.26 was associated with higher risk.