{"title":"改善STEMI预后:扩大无创心脏监测在GRACE评分之外的作用","authors":"Javeria Akhter, Javed Iqbal","doi":"10.1111/anec.70078","DOIUrl":null,"url":null,"abstract":"<p>We read with great interest the recent article by Xin et al. “Predictive Value of Noninvasive Cardiac Function Monitoring Combined with GRACE Score for Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction” which provides valuable insights into the potential of noninvasive cardiac function monitoring (NCFM) to augment risk stratification in patients with ST-segment elevation myocardial infarction (STEMI). The authors present a novel approach to improving prognostic accuracy for major adverse cardiovascular events (MACE) by integrating hemodynamic parameters with the established GRACE score (Xin et al. <span>2025</span>). Although the study contributes implicitly to the field, certain aspects warrant further discussion.</p><p>First, the study successfully demonstrates that stroke volume (SV), cardiac output (CO), cardiac index (CI), contractility index (CTI), early diastolic filling ratio (EDFR), end-diastolic volume (EDV), and systemic vascular resistance (SVR) are independent predictors of MACE. Moreover, the authors confirm that including SV and CTI into the GRACE score improves predictive performance. While this finding is promising, the study does not assess whether alternative combinations of hemodynamic parameters might offer even greater predictive accuracy. Considering the interaction of different cardiac function parameters, an exploratory analysis using machine-learning techniques such as decision trees or neural networks could help investigate the most effective predictors of short-term outcomes (Patel and Sengupta <span>2020</span>).</p><p>Second, while the study effectively underscores the added predictive value of NCFM in combination with the GRACE score, it does not provide adequate discussion on the probability of integrating NCFM into clinical practice. Extensive implementation of noninvasive cardiac monitoring entails considerations such as availability, cost-effectiveness, and user-friendliness in different healthcare settings (Kim et al. <span>2019</span>). Addressing these logistical concerns would enhance the study's clinical applicability and guide its possible adoption in routine patient management.</p><p>Third, the study does not consider probable confounding variables that may affect the predictive power of NCFM. Variables such as renal function, medication adherence, and previous cardiovascular interventions could affect both hemodynamic parameters and MACE outcomes (Chinwong et al. <span>2021</span>; Hussain et al. <span>2023</span>). Adjusting for these factors in a multivariate analysis would support the study's conclusions and provide more precise risk stratification.</p><p>Fourth, the study does not investigate the additional benefit of repeated NCFM measurements over time. Although the single-timepoint evaluation at admission provides valuable prognostic information, dynamic changes in cardiac function parameters post-STEMI may offer supplementary predictive value. Future research should assess whether serial NCFM measurements improve risk stratification beyond a single assessment.</p><p>Finally, while the study determines an improvement in predictive efficacy by altering the GRACE score, it does not compare this method against other recognized risk prediction models such as the TIMI risk score or the HEART score (Poldervaart et al. <span>2017</span>). Given that these models are generally used for risk stratification in acute coronary syndromes, a comparative analysis would help explain the relative benefits of including hemodynamic indicators in current scoring systems and determine whether the proposed model provides a meaningful benefit over existing clinical practice.</p><p>In conclusion, Xin et al. present a groundbreaking study that improves STEMI risk stratification by integrating noninvasive hemodynamic parameters with the GRACE score. However, additional research is needed to explore alternative predictive models, measure the possibility of clinical implementation, adjust for further confounding factors, and assess the effectiveness of serial NCFM measurements. We commend the authors for their input and encourage constant investigation into refining risk prediction in STEMI patients.</p><p>The authors take full responsibility for this article.</p><p>As this is a commentary on a published study and no new data were collected or analyzed, ethics approval was not required.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70078","citationCount":"0","resultStr":"{\"title\":\"Refining STEMI Prognosis: Expanding the Role of Noninvasive Cardiac Monitoring Beyond the GRACE Score\",\"authors\":\"Javeria Akhter, Javed Iqbal\",\"doi\":\"10.1111/anec.70078\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>We read with great interest the recent article by Xin et al. “Predictive Value of Noninvasive Cardiac Function Monitoring Combined with GRACE Score for Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction” which provides valuable insights into the potential of noninvasive cardiac function monitoring (NCFM) to augment risk stratification in patients with ST-segment elevation myocardial infarction (STEMI). The authors present a novel approach to improving prognostic accuracy for major adverse cardiovascular events (MACE) by integrating hemodynamic parameters with the established GRACE score (Xin et al. <span>2025</span>). Although the study contributes implicitly to the field, certain aspects warrant further discussion.</p><p>First, the study successfully demonstrates that stroke volume (SV), cardiac output (CO), cardiac index (CI), contractility index (CTI), early diastolic filling ratio (EDFR), end-diastolic volume (EDV), and systemic vascular resistance (SVR) are independent predictors of MACE. Moreover, the authors confirm that including SV and CTI into the GRACE score improves predictive performance. While this finding is promising, the study does not assess whether alternative combinations of hemodynamic parameters might offer even greater predictive accuracy. Considering the interaction of different cardiac function parameters, an exploratory analysis using machine-learning techniques such as decision trees or neural networks could help investigate the most effective predictors of short-term outcomes (Patel and Sengupta <span>2020</span>).</p><p>Second, while the study effectively underscores the added predictive value of NCFM in combination with the GRACE score, it does not provide adequate discussion on the probability of integrating NCFM into clinical practice. Extensive implementation of noninvasive cardiac monitoring entails considerations such as availability, cost-effectiveness, and user-friendliness in different healthcare settings (Kim et al. <span>2019</span>). Addressing these logistical concerns would enhance the study's clinical applicability and guide its possible adoption in routine patient management.</p><p>Third, the study does not consider probable confounding variables that may affect the predictive power of NCFM. Variables such as renal function, medication adherence, and previous cardiovascular interventions could affect both hemodynamic parameters and MACE outcomes (Chinwong et al. <span>2021</span>; Hussain et al. <span>2023</span>). Adjusting for these factors in a multivariate analysis would support the study's conclusions and provide more precise risk stratification.</p><p>Fourth, the study does not investigate the additional benefit of repeated NCFM measurements over time. Although the single-timepoint evaluation at admission provides valuable prognostic information, dynamic changes in cardiac function parameters post-STEMI may offer supplementary predictive value. Future research should assess whether serial NCFM measurements improve risk stratification beyond a single assessment.</p><p>Finally, while the study determines an improvement in predictive efficacy by altering the GRACE score, it does not compare this method against other recognized risk prediction models such as the TIMI risk score or the HEART score (Poldervaart et al. <span>2017</span>). Given that these models are generally used for risk stratification in acute coronary syndromes, a comparative analysis would help explain the relative benefits of including hemodynamic indicators in current scoring systems and determine whether the proposed model provides a meaningful benefit over existing clinical practice.</p><p>In conclusion, Xin et al. present a groundbreaking study that improves STEMI risk stratification by integrating noninvasive hemodynamic parameters with the GRACE score. However, additional research is needed to explore alternative predictive models, measure the possibility of clinical implementation, adjust for further confounding factors, and assess the effectiveness of serial NCFM measurements. We commend the authors for their input and encourage constant investigation into refining risk prediction in STEMI patients.</p><p>The authors take full responsibility for this article.</p><p>As this is a commentary on a published study and no new data were collected or analyzed, ethics approval was not required.</p><p>The authors declare no conflicts of interest.</p>\",\"PeriodicalId\":8074,\"journal\":{\"name\":\"Annals of Noninvasive Electrocardiology\",\"volume\":\"30 3\",\"pages\":\"\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-04-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70078\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Noninvasive Electrocardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/anec.70078\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Noninvasive Electrocardiology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/anec.70078","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
我们饶有兴趣地阅读了Xin等人最近发表的文章《无创心功能监测联合GRACE评分对st段抬高型心肌梗死患者短期预后的预测价值》,该文章对无创心功能监测(NCFM)在st段抬高型心肌梗死(STEMI)患者中增加风险分层的潜力提供了有价值的见解。作者提出了一种通过将血流动力学参数与既定GRACE评分相结合来提高主要不良心血管事件(MACE)预后准确性的新方法(Xin et al. 2025)。虽然这项研究对该领域有含蓄的贡献,但某些方面值得进一步讨论。首先,该研究成功地证明了卒中容量(SV)、心输出量(CO)、心脏指数(CI)、收缩性指数(CTI)、舒张早期充盈率(EDFR)、舒张末期容量(EDV)和全身血管阻力(SVR)是MACE的独立预测因子。此外,作者证实,将SV和CTI纳入GRACE评分可以提高预测性能。虽然这一发现很有希望,但该研究并没有评估血液动力学参数的替代组合是否可以提供更高的预测准确性。考虑到不同心功能参数的相互作用,使用决策树或神经网络等机器学习技术进行探索性分析可以帮助研究短期结果的最有效预测因素(Patel和Sengupta 2020)。其次,虽然该研究有效地强调了NCFM与GRACE评分相结合的附加预测价值,但它没有充分讨论将NCFM纳入临床实践的可能性。广泛实施无创心脏监测需要考虑不同医疗环境中的可用性、成本效益和用户友好性等因素(Kim et al. 2019)。解决这些后勤问题将提高该研究的临床适用性,并指导其在常规患者管理中的可能采用。第三,该研究没有考虑可能影响NCFM预测能力的混杂变量。肾功能、药物依从性和既往心血管干预等变量可能影响血流动力学参数和MACE结果(Chinwong et al. 2021;Hussain et al. 2023)。在多变量分析中调整这些因素将支持研究结论,并提供更精确的风险分层。第四,该研究没有调查随着时间的推移重复NCFM测量的额外益处。虽然入院时的单时间点评估提供了有价值的预后信息,但stemi后心功能参数的动态变化可能提供补充预测价值。未来的研究应该评估连续的NCFM测量是否比单一的评估更能改善风险分层。最后,虽然该研究通过改变GRACE评分确定了预测效果的提高,但它没有将该方法与其他公认的风险预测模型(如TIMI风险评分或HEART评分)进行比较(Poldervaart et al. 2017)。鉴于这些模型通常用于急性冠状动脉综合征的风险分层,比较分析将有助于解释在当前评分系统中纳入血流动力学指标的相对益处,并确定所提出的模型是否比现有的临床实践提供了有意义的益处。总之,Xin等人提出了一项开创性的研究,通过将无创血流动力学参数与GRACE评分相结合来改善STEMI风险分层。然而,需要进一步的研究来探索替代的预测模型,测量临床实施的可能性,调整进一步的混杂因素,并评估一系列NCFM测量的有效性。我们赞扬作者的投入,并鼓励不断研究改进STEMI患者的风险预测。作者对本文负全部责任。由于这是对已发表研究的评论,没有收集或分析新的数据,因此不需要伦理批准。作者声明无利益冲突。
Refining STEMI Prognosis: Expanding the Role of Noninvasive Cardiac Monitoring Beyond the GRACE Score
We read with great interest the recent article by Xin et al. “Predictive Value of Noninvasive Cardiac Function Monitoring Combined with GRACE Score for Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction” which provides valuable insights into the potential of noninvasive cardiac function monitoring (NCFM) to augment risk stratification in patients with ST-segment elevation myocardial infarction (STEMI). The authors present a novel approach to improving prognostic accuracy for major adverse cardiovascular events (MACE) by integrating hemodynamic parameters with the established GRACE score (Xin et al. 2025). Although the study contributes implicitly to the field, certain aspects warrant further discussion.
First, the study successfully demonstrates that stroke volume (SV), cardiac output (CO), cardiac index (CI), contractility index (CTI), early diastolic filling ratio (EDFR), end-diastolic volume (EDV), and systemic vascular resistance (SVR) are independent predictors of MACE. Moreover, the authors confirm that including SV and CTI into the GRACE score improves predictive performance. While this finding is promising, the study does not assess whether alternative combinations of hemodynamic parameters might offer even greater predictive accuracy. Considering the interaction of different cardiac function parameters, an exploratory analysis using machine-learning techniques such as decision trees or neural networks could help investigate the most effective predictors of short-term outcomes (Patel and Sengupta 2020).
Second, while the study effectively underscores the added predictive value of NCFM in combination with the GRACE score, it does not provide adequate discussion on the probability of integrating NCFM into clinical practice. Extensive implementation of noninvasive cardiac monitoring entails considerations such as availability, cost-effectiveness, and user-friendliness in different healthcare settings (Kim et al. 2019). Addressing these logistical concerns would enhance the study's clinical applicability and guide its possible adoption in routine patient management.
Third, the study does not consider probable confounding variables that may affect the predictive power of NCFM. Variables such as renal function, medication adherence, and previous cardiovascular interventions could affect both hemodynamic parameters and MACE outcomes (Chinwong et al. 2021; Hussain et al. 2023). Adjusting for these factors in a multivariate analysis would support the study's conclusions and provide more precise risk stratification.
Fourth, the study does not investigate the additional benefit of repeated NCFM measurements over time. Although the single-timepoint evaluation at admission provides valuable prognostic information, dynamic changes in cardiac function parameters post-STEMI may offer supplementary predictive value. Future research should assess whether serial NCFM measurements improve risk stratification beyond a single assessment.
Finally, while the study determines an improvement in predictive efficacy by altering the GRACE score, it does not compare this method against other recognized risk prediction models such as the TIMI risk score or the HEART score (Poldervaart et al. 2017). Given that these models are generally used for risk stratification in acute coronary syndromes, a comparative analysis would help explain the relative benefits of including hemodynamic indicators in current scoring systems and determine whether the proposed model provides a meaningful benefit over existing clinical practice.
In conclusion, Xin et al. present a groundbreaking study that improves STEMI risk stratification by integrating noninvasive hemodynamic parameters with the GRACE score. However, additional research is needed to explore alternative predictive models, measure the possibility of clinical implementation, adjust for further confounding factors, and assess the effectiveness of serial NCFM measurements. We commend the authors for their input and encourage constant investigation into refining risk prediction in STEMI patients.
The authors take full responsibility for this article.
As this is a commentary on a published study and no new data were collected or analyzed, ethics approval was not required.
期刊介绍:
The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients.
ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation.
ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.