狼牙棒
医学
心脏病学
射血分数
内科学
心肌梗塞
危险系数
蒂米
心力衰竭
经皮冠状动脉介入治疗
溶栓
冲程容积
置信区间
心脏磁共振成像
磁共振成像
放射科
作者
Johannes P. Schwaiger,Sebastian J. Reinstadler,Magdalena Holzknecht,Christina Tiller,Martin Reindl,Jana Begle,Ivan Lechner,Claudia Lamina,Agnes Mayr,Ivo Graziadei,Axel Bauer,Bernhard Metzler,Gert Klug
出处
期刊:European heart journal. Acute cardiovascular care
[Oxford University Press]
日期:2021-10-18
卷期号:11 (1): 53-61
标识
DOI:10.1093/ehjacc/zuab098
摘要
An invasively measured cardiac index (CI) of ≤2.2 L/min/m2 is one of the strongest prognostic indicators after ST-elevation myocardial infarction (STEMI), however, knowledge is mainly based on invasive evaluations performed in the pre-stent era. Velocity-encoded phase-contrast cardiac magnetic resonance (PC-CMR) allows non-invasive determination of CI.In this prospective study, CMR was performed in 406 stable and contemporarily revascularized patients a median of 3 days after STEMI. Forward stroke volume was assessed at the level of the ascending aorta by PC-CMR. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were determined by cine CMR. Major adverse cardiac events (MACE) were defined as the composite of death, myocardial infarction, or hospitalization for heart failure. Median CI was 2.52 L/min/m2 and 27% of patients had ≤2.2 L/min/m2. Median LVEF was 53% and median GLS was -12.2%. During a median follow-up of 14.2 [95% confidence interval (95% CI) 13.6-14.7] months, 41 patients (10.1%) experienced a MACE. A depressed CI was significantly associated with MACE after adjustment for LVEF, GLS, Thrombolysis in Myocardial Infarction (TIMI) risk score, and infarct size [hazard ratio = 3.15 (95% CI 1.53-6.47); P = 0.002] and led to significant discrimination improvement [net reclassification improvement 0.61 (95% CI 0.25-0.97); P < 0.001].A CI of 2.2 L/min/m2 or less as measured by PC-CMR was present in 27% of clinically stable patients after STEMI and strongly and independently predicted medium-term MACE. The prognostic value of a depressed CI was superior and incremental to LVEF, GLS, TIMI risk score, and infarct size.
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