Zhenyan Ma, Xin A, Lei Zhao, Hongbo Zhang, Ke Liu, Yiqing Zhao, Geng Qian
{"title":"基于心脏磁共振的急性st段抬高型心肌梗死经皮冠状动脉介入治疗后左室不良重构风险预测模型：一项多中心前瞻性研究。","authors":"Zhenyan Ma, Xin A, Lei Zhao, Hongbo Zhang, Ke Liu, Yiqing Zhao, Geng Qian","doi":"10.12122/j.issn.1673-4254.2025.04.01","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>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).</p><p><strong>Methods: </strong>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 end-diastolic volume or >15% in left ventricular end-systolic volume at 6 months compared to baseline. The patients were randomized into training (<i>n</i>=230) and validation (<i>n</i>=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.</p><p><strong>Results: </strong>LVAR occurred in 100 patients (30.40%), who had a higher incidence of major adverse cardiovascular events than those without LVAR (58.00% <i>vs</i> 16.16%, <i>P</i><0.001). Left ventricular global longitudinal strain (LVGLS; OR=0.76, 95% <i>CI</i>: 0.61-0.95, <i>P</i>=0.015) and left atrial active strain (LAAS; OR=0.78, 95% <i>CI</i>: 0.67-0.92, <i>P</i>=0.003) were protective factors for LVAR, while infarct size (IS; OR=1.05, 95% <i>CI</i>: 1.01-1.10, <i>P</i>=0.017) and microvascular obstruction (MVO; OR=1.26, 95% <i>CI</i>: 1.01-1.59, <i>P</i>=0.048) were risk factors for LVAR. The nomogram had an AUC of 0.90 (95% <i>CI</i>: 0.86-0.94) in the training set and an AUC of 0.88 (95% <i>CI</i>: 0.81-0.94) in the validation set.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18962,"journal":{"name":"南方医科大学学报杂志","volume":"45 4","pages":"669-683"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037290/pdf/","citationCount":"0","resultStr":"{\"title\":\"[A cardiac magnetic resonance-based risk prediction model for left ventricular adverse remodeling following percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a multi-center prospective study].\",\"authors\":\"Zhenyan Ma, Xin A, Lei Zhao, Hongbo Zhang, Ke Liu, Yiqing Zhao, Geng Qian\",\"doi\":\"10.12122/j.issn.1673-4254.2025.04.01\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>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).</p><p><strong>Methods: </strong>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 end-diastolic volume or >15% in left ventricular end-systolic volume at 6 months compared to baseline. The patients were randomized into training (<i>n</i>=230) and validation (<i>n</i>=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.</p><p><strong>Results: </strong>LVAR occurred in 100 patients (30.40%), who had a higher incidence of major adverse cardiovascular events than those without LVAR (58.00% <i>vs</i> 16.16%, <i>P</i><0.001). Left ventricular global longitudinal strain (LVGLS; OR=0.76, 95% <i>CI</i>: 0.61-0.95, <i>P</i>=0.015) and left atrial active strain (LAAS; OR=0.78, 95% <i>CI</i>: 0.67-0.92, <i>P</i>=0.003) were protective factors for LVAR, while infarct size (IS; OR=1.05, 95% <i>CI</i>: 1.01-1.10, <i>P</i>=0.017) and microvascular obstruction (MVO; OR=1.26, 95% <i>CI</i>: 1.01-1.59, <i>P</i>=0.048) were risk factors for LVAR. The nomogram had an AUC of 0.90 (95% <i>CI</i>: 0.86-0.94) in the training set and an AUC of 0.88 (95% <i>CI</i>: 0.81-0.94) in the validation set.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":18962,\"journal\":{\"name\":\"南方医科大学学报杂志\",\"volume\":\"45 4\",\"pages\":\"669-683\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037290/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"南方医科大学学报杂志\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.12122/j.issn.1673-4254.2025.04.01\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"南方医科大学学报杂志","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12122/j.issn.1673-4254.2025.04.01","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
[A cardiac magnetic resonance-based risk prediction model for left ventricular adverse remodeling following percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a multi-center prospective study].
Objectives: 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 end-diastolic 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.
Conclusions: 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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
