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.
10.12122/j.issn.1673-4254.2025.04.01
- Author:
Zhenyan MA
1
;
Xin A
2
;
Lei ZHAO
3
;
Hongbo ZHANG
3
;
Ke LIU
1
;
Yiqing ZHAO
1
;
Geng QIAN
4
Author Information
1. Medical School of Chinese PLA, Beijing 100039, China.
2. Seventh Department of Health Care, Second Medical Center, Chinese PLA General Hospital, Beijing 100039, China.
3. Department of Radiology, Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China.
4. Senior Department of Cardiology Disease Medicine, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China.
- Publication Type:English Abstract
- Keywords:
acute ST-elevation myocardial infarction;
cardiac magnetic resonance;
left ventricular adverse remodeling;
nomogram
- MeSH:
Humans;
Percutaneous Coronary Intervention;
Prospective Studies;
ST Elevation Myocardial Infarction/diagnostic imaging*;
Ventricular Remodeling;
Magnetic Resonance Imaging;
Male;
Female;
Middle Aged;
Risk Factors;
Aged;
Risk Assessment
- From:
Journal of Southern Medical University
2025;45(4):669-683
- CountryChina
- Language:Chinese
-
Abstract:
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.
