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
MA Zhenyan
A Xin
ZHAO Lei
ZHANG Hongbo
LIU Ke
ZHAO Yiqing
QIAN Geng
Abstract：Objective 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.Conclusion 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.
Keywords：left ventricular adverse remodelingacute ST-elevation myocardial infarctioncardiac magnetic resonancenomogram
Publication Date：2025-04-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：15( 669-683 )