cmr衍生的细胞外体积对非阻塞性冠状动脉心肌梗死的预后价值

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2025-06-18 DOI:10.1016/j.ijcard.2025.133528

Lei Chen , Liqi Ge , Fuad A. Abdu , Xinjia Du , Jiahua Liu , Wensu Chen , Yuan Lu , Wenliang Che

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引用次数: 0

摘要

心脏磁共振（CMR）对于诊断非阻塞性冠状动脉（MINOCA）心肌梗死至关重要，目前的指南推荐其诊断和预后能力。然而，CMR参数，特别是细胞外体积（ECV）在预测MINOCA主要不良心血管事件（MACE）中的预后价值仍不清楚。本研究分析了ECV在不同MINOCA病因中的分布及其对“真实”MINOCA中MACE的预测价值。方法纳入经CMR诊断为MINOCA的连续患者。我们研究了“真实”MINOCA中CMR参数与MACE之间的关系。采用Cox回归和ROC曲线分析评价ECV对MACE的预测作用。“真正的”MINOCA是通过CMR上的缺血或梗死证据来定义的。结果275例MINOCA确诊患者（中位4天至CMR）中，96例诊断为“真”MINOCA， 66例为心肌炎，31例为Takotsubo综合征（TS）， 34例为心肌病，48例表现正常。与其他病因相比，“真”MINOCA具有更高的ECV (29.10% vs 26.00%, P <；0.001)。在26.6个月的中位随访期间，29.2%的“真正”MINOCA患者经历了MACE。在调整后的Cox模型中，ECV （HR 1.063, 95% CI 1.019-1.108, P = 0.004）是“真”MINOCA患者MACE的独立预测因子。根据ROC的最佳截断值，ECV = 28.94%的患者MACE风险显著升高(log-rank P = lt；0.001)。结论scmr衍生的ECV因MINOCA病因而异，“真”MINOCA的ECV水平较高。ECV升高独立预测“真正的”MINOCA患者MACE风险增加。试验注册号：ClinicalTrials.gov （ID: NCT06502899）。

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Prognostic value of CMR-derived extracellular volume in myocardial infarction with non-obstructive coronary arteries

Background

Cardiac magnetic resonance (CMR) is crucial for diagnosing myocardial infarction with non-obstructive coronary arteries (MINOCA) and is recommended by current guidelines for its diagnostic and prognostic capabilities. However, the prognostic value of CMR parameters, particularly extracellular volume (ECV), in predicting major adverse cardiovascular events (MACE) among MINOCA remains unclear. This study analyzes ECV distribution across different MINOCA etiologies and its predictive value for MACE in “true” MINOCA.

Methods

Consecutive patients with a working diagnosis of MINOCA who underwent CMR were included. We investigated the relationships between CMR parameters and MACE in “true” MINOCA. Cox regression and ROC curve analyses were used to assess ECV in predicting MACE. “True” MINOCA was defined by evidence of ischemia or infarction on CMR.

Results

Among 275 patients with a working diagnosis of MINOCA (median 4 days to CMR), 96 were diagnosed with “true” MINOCA, 66 with myocarditis, 31 with Takotsubo syndrome (TS), 34 with cardiomyopathies, and 48 had normal findings. “True” MINOCA had higher ECV compared to other etiologies (29.10 % vs. 26.00 %, P < 0.001). During a median follow-up of 26.6 months, 29.2 % of “true” MINOCA patients experienced MACE. In the adjusted Cox model, ECV (HR 1.063, 95 % CI 1.019–1.108, P = 0.004) was an independent predictor of MACE in patients with “true” MINOCA. According to optimal cut-off values from ROC, patients with ECV >28.94 % had a significantly higher MACE risk (log-rank P < 0.001).

Conclusions

CMR-derived ECV varies by MINOCA etiology, with higher levels in “true” MINOCA. Elevated ECV independently predicts increased MACE risk in “true” MINOCA patients.

Trial registration number: ClinicalTrials.gov (ID: NCT06502899).

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.