Prognostic value of extracellular volume fraction in myocardial infarction and myocardial infarction with nonobstructive coronary arteries: A multicenter study

IF 3.8 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Academic Radiology Pub Date : 2025-03-01 DOI:10.1016/j.acra.2024.11.015

Bowen Li MD , Yan Gao MD , Jian Wang MD , Runze Zhu MD , Shifeng Yang MD, PhD , Congshan Ji MD, PhD , Ying Wang MD , Ximing Wang MD, PhD , Hui Gu MD, PhD

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Abstract

Rationale and Objectives

The aim of the present retrospective study was to evaluate the prognostic role of the extracellular volume fraction (ECV) in patients with myocardial infarction (MI) and myocardial infarction with nonobstructive coronary arteries (MINOCA). The present study hypothesized that ECV is associated with major adverse cardiovascular events (MACEs) in MI and MINOCA patients.

Materials and Methods

Cardiac magnetic resonance (CMR) imaging was performed on 351 consecutive patients (mean age: 58 ± 12 years; 252 [71.8%] males) who were diagnosed with MI between October 2015 and November 2023. From CMR imaging, the extent of late gadolinium enhancement (LGE), native T1 and ECV were derived. Patients were categorized into groups according to the degree of coronary artery stenosis, namely, patients with MINOCA and patients with obstructive MI. Follow-up was performed to assess MACEs.

Results

The final cohort consisted of 61 MINOCA patients and 290 obstructive MI patients. During a mean follow-up of 27 ± 16 months, there was no statistically significant difference in the incidence of MACEs between patients with MINOCA and those with obstructive MI, and the two groups of patients had similar ECVs (32.2 ± 3.6 vs. 32.3 ± 6.0, p = 0.864). According to the multivariate Cox regression, ECV was an independent predictor of MACEs (HR: 1.13; p < 0.001) and significantly improved the prognostic value of the baseline multivariate models (C-statistic improvement: 0.816–0.864, p = 0.001). Similarly, ECV maintained an independent association with MACEs in the MINOCA (HR: 1.35; p < 0.001) and obstructive MI (HR: 1.13; p < 0.001) groups.

Conclusion

In MI and MINOCA patients, ECV is an independent predictor of MACEs. MINOCA is not a benign disease, and its long-term prognosis is as poor as that of patients with obstructive MI.

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细胞外体积分数对心肌梗死和冠状动脉非阻塞性心肌梗死的预后价值：一项多中心研究。

依据和目的：本回顾性研究旨在评估细胞外体积分数（ECV）在心肌梗死（MI）和冠状动脉非阻塞性心肌梗死（MINOCA）患者中的预后作用。本研究假设 ECV 与 MI 和 MINOCA 患者的主要不良心血管事件（MACE）有关：对 2015 年 10 月至 2023 年 11 月期间被诊断为心肌梗死的 351 名连续患者（平均年龄：58 ± 12 岁；252 名[71.8%]男性）进行了心脏磁共振（CMR）成像。通过 CMR 成像，得出了晚期钆增强 (LGE)、原生 T1 和 ECV 的程度。根据冠状动脉狭窄程度将患者分为两组，即 MINOCA 患者和阻塞性 MI 患者。进行随访以评估MACEs：最终结果：61 名 MINOCA 患者和 290 名阻塞性 MI 患者组成了最终队列。在平均 27 ± 16 个月的随访期间，MINOCA 患者和梗阻性心肌梗死患者的 MACE 发生率没有明显的统计学差异，两组患者的 ECV 值相似（32.2 ± 3.6 vs. 32.3 ± 6.0，p = 0.864）。根据多变量 Cox 回归，ECV 是 MACEs 的独立预测因子（HR：1.13；P 结论：ECV 是 MACEs 的独立预测因子：在心肌梗死和 MINOCA 患者中，ECV 是 MACEs 的独立预测因子。MINOCA 并非良性疾病，其长期预后与梗阻性 MI 患者一样差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Radiology 医学-核医学

CiteScore

7.60

自引率

10.40%

发文量

432

审稿时长

18 days

期刊介绍： Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.