摘要
目的基于急性ST段抬高型心肌梗死(STEMI)患者的心脏磁共振(CMR)参数构建左心室不良重构(LVAR)风险预测模型。方法前瞻性纳入2018年1月~2021年12月在8个医学中心接受直接经皮冠状动脉介入治疗(PCI)的急性STEMI患者329例。分别于PCI术后7±2 d及术后6个月进行CMR检查。采用CVI42软件分析CMR参数。LVAR定义为PCI术后6月左心室舒张末期容积较基线(术后7±2 d)增加超过20%,或左心室收缩末期容积较基线增加超过15%。所有患者按照7∶3的比例随机分为训练集(n=230)和验证集(n=99)。在训练集中,首先通过LASSO回归筛选出潜在的预测因子,然后进行单因素和多因素Logistic回归分析,以识别具有独立预测价值的变量,并构建列线图。通过受试者工作特征曲线、曲线下面积(AUC)、校准曲线和决策曲线分析,评估列线图在训练集和验证集中的区分度、校准度和临床应用价值。结果根据LVAR的定义,患者分为LVAR组(n=100,30.40%)和无重构组(n=229,69.60%)。LVAR组心血管主要不良事件发生率明显高于无重构组(58.00%vs 16.16%,P<0.001)。单因素和多因素Logistic回归分析发现,左心室整体纵向应变(LVGLS)[OR=0.76,95%CI(0.61-0.95),P=0.015]、左心房主动应变(LAAS)[OR=0.78,95%CI(0.67-0.92),P=0.003]是LVAR的保护因素。而梗死面积(IS)[OR=1.05,95%CI(1.01-1.10),P=0.017]、微血管阻塞(MVO)[OR=1.26,95%CI(1.01-1.59),P=0.048]是LVAR的危险因素。列线图在训练集中的AUC值为0.90(95%CI:0.86-0.94),在验证集中AUC值为0.88(95%CI:0.81-0.94)。结论本研究基于急性STEMI患者的CMR参数,识别出4个LVAR的独立预测因子:LVGLS、LAAS、IS、MVO。基于这4个变量构建的列线图预测性能良好,可为急性STEMI患者的临床管理和早期干预提供重要依据。
Objective To develop a risk prediction model for left ventricular adverse remodeling(LVAR)based on cardiac magnetic resonance(CMR)parameters in patients undergoing percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 329 acute STEMI patients undergoing primary PCI at 8 medical centers from January,2018 to December,2021 were prospectively enrolled.The parameters of CMR,performed at 7±2 days and 6 months post-PCI,were analyzed using CVI42 software.LVAR was defined as an increase>20%in left ventricular enddiastolic volume or>15%in left ventricular end-systolic volume at 6 months compared to baseline.The patients were randomized into training(n=230)and validation(n=99)sets in a 7∶3 ratio.In the training set,potential predictors were selected using LASSO regression,followed by univariate and multivariate logistic regression to construct a nomogram.Model performance was evaluated using receiver-operating characteristic(ROC)curves,area under the curve(AUC),calibration curves,and decision curve analysis.Results LVAR occurred in 100 patients(30.40%),who had a higher incidence of major adverse cardiovascular events than those without LVAR(58.00%vs 16.16%,P<0.001).Left ventricular global longitudinal strain(LVGLS;OR=0.76,95%CI:0.61-0.95,P=0.015)and left atrial active strain(LAAS;OR=0.78,95%CI:0.67-0.92,P=0.003)were protective factors for LVAR,while infarct size(IS;OR=1.05,95%CI:1.01-1.10,P=0.017)and microvascular obstruction(MVO;OR=1.26,95%CI:1.01-1.59,P=0.048)were risk factors for LVAR.The nomogram had an AUC of 0.90(95%CI:0.86-0.94)in the training set and an AUC of 0.88(95%CI:0.81-0.94)in the validation set.Conclusion LVGLS,LAAS,IS,and MVO are independent predictors of LVAR in STEMI patients following PCI.The constructed nomogram has a strong predictive ability to provide assistance for management and early intervention of LVAR.
作者
马振岩
阿鑫
赵蕾
张洪博
刘科
赵依晴
钱赓
MA Zhenyan;A Xin;ZHAO Lei;ZHANG Hongbo;LIU Ke;ZHAO Yiqing;QIAN Geng(Medical School of Chinese PLA,Beijing 100039,China;Seventh Department of Health Care,Second Medical Center,Chinese PLA General Hospital,Beijing 100039,China;Department of Radiology,Beijing Anzhen Hospital of Capital Medical University,Beijing 100029,China;Senior Department of Cardiology Disease Medicine,Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)
出处
《南方医科大学学报》
北大核心
2025年第4期669-683,共15页
Journal of Southern Medical University
基金
中华心血管病发展专项基金心脏健康科研基金项目(Z-2019-42-1908-2)
首都卫生发展科研专项项目(SF2020-2-5012)。
关键词
左心室不良重构
急性ST段抬高型心肌梗死
心脏磁共振
列线图
left ventricular adverse remodeling
acute STelevation myocardial infarction
cardiac magnetic resonance
nomogram
