Understanding and improving risk assessment after myocardial infarction using automated left ventricular shape analysis
| Autor: | Jorge Corral Acero, Andreas Schuster, Ernesto Zacur, Torben Lange, Thomas Stiermaier, Sören J. Backhaus, Holger Thiele, Alfonso Bueno-Orovio, Pablo Lamata, Ingo Eitel, Vicente Grau |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Male
Myocardial Infarction Stroke Volume Middle Aged 030204 cardiovascular system & hematology Prognosis Risk Assessment Ventricular Function Left 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Predictive Value of Tests Humans Female Radiology Nuclear Medicine and imaging 030212 general & internal medicine Cardiology and Cardiovascular Medicine |
| Zdroj: | JACC: Cardiovascular Imaging |
| DOI: | 10.1016/j.jcmg.2021.11.027 |
| Popis: | Objectives This study aimed to identify novel 3-dimensional (3D) imaging end-systolic (ES) shape and contraction descriptors toward risk-related features and superior prognosis in acute myocardial infarction (AMI). Background Left ventricular ejection fraction (LVEF) and end-systolic volume (ESV) remain the main imaging biomarkers for post-AMI risk stratification. However, they are limited to global systolic function and fail to capture functional and anatomical regional abnormalities, hindering their performance in risk stratification. Methods A multicenter cohort of AMI survivors (n = 1,021; median age 63 years; 74.5% male) who underwent cardiac magnetic resonance (CMR) at a median of 3 days after infarction were considered for this study. The clinical end point was the 12-month rate of major adverse cardiac events (MACE; n = 73), consisting of all-cause death, reinfarction, and new congestive heart failure. A fully automated pipeline was developed to segment CMR images, build 3D statistical models of shape and contraction in AMI, and find the 3D patterns related to MACE occurrence. Results The novel ES shape markers proved to be superior to ESV (median cross-validated area under the receiver-operating characteristic curve 0.681 [IQR 0.679-0.684] vs 0.600 [0.598-0.602]; P < 0.001); and 3D contraction to LVEF (0.716 [0.714-0.718] vs 0.681 [0.679-0.684]; P < 0.001) in MACE occurrence prediction. They also contributed to a significant improvement in a multivariable setting including CMR markers, cardiovascular risk factors, and basic patient characteristics (0.747 [0.745-0.749]; P < 0.001). Based on these novel 3D descriptors, 3 impairments caused by AMI were identified: global, anterior, and basal, the latter being the most complementary signature to already known predictors. Conclusions The quantification of 3D differences in ES shape and contraction, enabled by a fully automated pipeline, improves post-AMI risk prediction and identifies shape and contraction patterns related to MACE occurrence. |
| Databáze: | OpenAIRE |
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