Share：
Share this content in WeChat
X
[Chinese] [PDF] 195 7
• Clinical Article •
Predictive value of electrocardiographic Q waves and CMR myocardial strain for microcirculatory obstruction after PCI treatment in patients with acute ST-elevation myocardial infarction
LIU Suning  YE Wenying  ZHANG Ziqian  ZHOU Ying 

DOI:10.12015/issn.1674-8034.2025.08.010.


[Abstract] Objective This study investigates the predictive value of cardiac magnetic resonance (CMR) myocardial strain, hospital admission electrocardiogram Q waves, and their combination for microvascular obstruction (MVO) following percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Materials and Methods A retrospective analysis was conducted on the clinical and imaging data of 40 control cases and 133 acute STEMI patients who underwent direct PCI for the first time and underwent CMR examination 3 to 7 days post-treatment between September 2021 and September 2024. Acute STEMI patients were divided into the NQ group and Q group based on the presence or absence of pathological Q waves on the admission electrocardiogram, and a comparative analysis was performed to identify differences in clinical and imaging data between the two groups. Based on CMR examination results, acute STEMI patients were divided into MVO and non-MVO groups. Logistic regression analysis was used to assess the independent association of each parameter with MVO, and receiver operating characteristic (ROC) curves were plotted to evaluate predictive performance. A combined predictive model was established to analyse the predictive efficacy for MVO.Results The acute STEMI group had significantly higher Q-wave width, Q-wave depth, total cholesterol, triglycerides, fasting blood glucose, glycated haemoglobin, preoperative troponin, preoperative creatine kinase, preoperative creatine kinase isoenzymes, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) were all higher than those in the control group, with statistically significant differences (P < 0.05). In the acute STEMI group, left ventricular ejection fraction (LVEF), global circumferential strain (GCS), global radial strain on the short axis (GRSSAX), global radial strain on the long axis (GRSLAX), and global longitudinal strain (GLS) were all lower than those in the control group. In the Q group, the Q wave width at admission, Q wave depth at admission, preoperative troponin, preoperative creatine kinase, preoperative creatine kinase isoenzymes, infarct size (IS), transmural infarction patients, patients with MVO, the proportion of MVO in the left ventricular myocardium, and LVESV were all higher than those in the NQ group, with statistically significant differences (P < 0.05). The Q group had lower LVEF, GCS, GRSSAX, GRSLAX, and GLS than the NQ group, with statistically significant differences (P < 0.05). The Q wave depth at admission was significantly higher in the MVO group than in the non-MVO group (P < 0.05). Logistic regression analysis showed that GLS, GCS, and GRSSAX were independent predictors of MVO (P < 0.05). GLS, GCS, and GRSSAX were significantly reduced in the MVO group (P < 0.05), with GRSSAX exhibiting the highest predictive efficacy for MVO, with an area under the curve of 0.791. The combination of admission Q-wave depth and GRSSAX demonstrated superior predictive performance for MVO compared to the use of admission Q-wave depth or CMR myocardial strain parameters alone, with an area under the curve of 0.824.Conclusions The depth of the Q wave at admission and CMR myocardial strain parameters have predictive value for MVO after PCI in patients with acute STEMI. In addition, the combination of Q wave depth at admission and GRSSAX can further improve the accuracy of predicting the risk of MVO.
[Keywords] ST-segment elevation myocardial infarction；cardiac magnetic resonance；myocardial strain；pathological Q-wave；microvascular obstruction

LIU Suning   YE Wenying   ZHANG Ziqian   ZHOU Ying*  

Department of Medical Imaging, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, China

Corresponding author: ZHOU Y, E-mail: zhouying261@163.com

Conflicts of interest   None.

Received  2025-06-06
Accepted  2025-08-06
DOI: 10.12015/issn.1674-8034.2025.08.010
DOI:10.12015/issn.1674-8034.2025.08.010.

[1]
THYGESEN K, ALPERT J S, JAFFE A S, et al. Fourth universal definition of myocardial infarction (2018)[J]. J Am Coll Cardiol, 2018, 72(18): 2231-2264. DOI: 10.1016/j.jacc.2018.08.1038.
[2]
YE J, ZONG W X, WU X, et al. Quantitative evaluation of acute myocardial infarction by feature-tracking cardiac magnetic resonance imaging[J]. Pak J Med Sci, 2023, 39(3): 804-808. DOI: 10.12669/pjms.39.3.7248.
[3]
CHEN G L, GAN J, WU F, et al. Scpep1 inhibition attenuates myocardial infarction-induced dysfunction by improving mitochondrial bioenergetics[J]. Eur Heart J, 2025, 46(26): 2579-2594. DOI: 10.1093/eurheartj/ehaf032.
[4]
CARRICK D, HAIG C, RAUHALAMMI S, et al. Pathophysiology of LV remodeling in survivors of STEMI: inflammation, remote myocardium, and prognosis[J]. JACC Cardiovasc Imaging, 2015, 8(7): 779-789. DOI: 10.1016/j.jcmg.2015.03.007.
[5]
HU Y Y, GUO Y, SUN Z, et al. Diagnostic value of cardiac magnetic contrast-enhanced cine sequences in STEMI patients with microvascular obstruction[J]. Chin J Magn Reson Imag, 2024, 15(2): 140-146. DOI: 10.12015/issn.1674-8034.2024.02.021.
[6]
AKHTAR K H, KHAN M S, BARON S J, et al. The spectrum of post-myocardial infarction care: From acute ischemia to heart failure[J/OL]. Prog Cardiovasc Dis, 2024, 82: 15-25 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/38242191/. DOI: 10.1016/j.pcad.2024.01.017.
[7]
DE MARIA G L, GREENWOOD J P, ZAMAN A G, et al. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) in acute myocardial infarction: the PiCSO-AMI-I trial[J/OL]. Circ Cardiovasc Interv, 2024, 17(4): e013675 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/38626079/. DOI: 10.1161/CIRCINTERVENTIONS.123.013675.
[8]
ARAI H, KAWAKUBO M, TRIADYAKSA P, et al. Non-contrast-enhanced multiparametric cardiac magnetic resonance reveals coronary microvascular functional and structural obstruction after percutaneous coronary intervention[J/OL]. Eur Radiol, 2025 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/40097843/. DOI: 10.1007/s00330-025-11496-2.
[9]
ERLEY J, STAREKOVA J, SINN M, et al. Cardiac magnetic resonance feature tracking global and segmental strain in acute and chronic ST-elevation myocardial infarction[J/OL]. Sci Rep, 2022, 12(1): 22644 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/36587037/. DOI: 10.1038/s41598-022-26968-4.
[10]
HAMIRANI Y S, WONG A, KRAMER C M, et al. Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis[J]. JACC Cardiovasc Imaging, 2014, 7(9): 940-952. DOI: 10.1016/j.jcmg.2014.06.012.
[11]
LECHNER I, REINDL M, STIERMAIER T, et al. Clinical outcomes associated with various microvascular injury patterns identified by CMR after STEMI[J]. J Am Coll Cardiol, 2024, 83(21): 2052-2062. DOI: 10.1016/j.jacc.2024.03.408.
[12]
TURGUT Ö, MÜLLER P, HAGER P, et al. Unlocking the diagnostic potential of electrocardiograms through information transfer from cardiac magnetic resonance imaging[J/OL]. Med Image Anal, 2025, 101: 103451 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/39793216/. DOI: 10.1016/j.media.2024.103451.
[13]
MITSIS A, GRAGNANO F. Myocardial infarction with and without ST-segment elevation: a contemporary reappraisal of similarities and differences[J/OL]. Curr Cardiol Rev, 2021, 17(4): e230421189013 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/33305709/. DOI: 10.2174/1573403X16999201210195702.
[14]
TOPAL D G, LØNBORG J, AHTAROVSKI K A, et al. Early Q-wave morphology in prediction of reperfusion success in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention - A cardiac magnetic resonance imaging study[J/OL]. J Electrocardiol, 2020, 58: 135-142 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/31869764/. DOI: 10.1016/j.jelectrocard.2019.12.011.
[15]
BENZ D C, GRÄNI C, ANTIOCHOS P, et al. Cardiac magnetic resonance biomarkers as surrogate endpoints in cardiovascular trials for myocardial diseases[J]. Eur Heart J, 2023, 44(45): 4738-4747. DOI: 10.1093/eurheartj/ehad510.
[16]
RAJIAH P S, MOORE A, BRONCANO J, et al. Diastology with cardiac MRI: a practical guide[J/OL]. Radiographics, 2023, 43(9): e220144 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/37535462/. DOI: 10.1148/rg.220144.
[17]
XU S F, WANG Z X, ZHAO S, et al. Value of cardiac magnetic resonance feature tracking technique in evaluating cardiac function during chemotherapy in breast cancer patients[J]. Chin J Magn Reson Imag, 2024, 15(5): 87-93. DOI: 10.12015/issn.1674-8034.2024.05.015.
[18]
LU M J, ZHU L Y, PRASAD S K, et al. Magnetic resonance imaging mimicking pathology detects myocardial fibrosis: a door to hope for improving the whole course management[J]. Sci Bull (Beijing), 2023, 68(9): 864-867. DOI: 10.1016/j.scib.2023.04.014.
[19]
LIU Y H, LI W, OUYANG L N, et al. Preliminary study of CMR tissue feature tracking technology on left ventricular function in patients with hypertrophic cardiomyopathy with ejection fraction preservation[J]. Chin J Magn Reson Imag, 2022, 13(1): 31-36. DOI: 10.12015/issn.1674-8034.2022.01.007.
[20]
SMISETH O A, RIDER O, CVIJIC M, et al. Myocardial strain imaging: theory, current practice, and the future[J]. JACC Cardiovasc Imaging, 2025, 18(3): 340-381. DOI: 10.1016/j.jcmg.2024.07.011.
[21]
TILLER C, REINDL M, HOLZKNECHT M, et al. Relationship between admission Q waves and microvascular injury in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention[J/OL]. Int J Cardiol, 2019, 297: 1-7 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/31629564/. DOI: 10.1016/j.ijcard.2019.10.009.
[22]
IBANEZ B, JAMES S, AGEWALL S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2018, 39(2): 119-177. DOI: 10.1093/eurheartj/ehx393.
[23]
CHEN S, REDFORS B, CROWLEY A, et al. Relationship between primary percutaneous coronary intervention time of day, infarct size, microvascular obstruction and prognosis in ST-segment elevation myocardial infarction[J]. Coron Artery Dis, 2021, 32(4): 267-274. DOI: 10.1097/MCA.0000000000000990.
[24]
SUN Y M, ZHANG L L, ZHANG C H. Health assessment[M]. 5th ed. Beijing: People's Medical Publishing House, 2021.
[25]
DIZON J M, BRENER S J, MAEHARA A, et al. Relationship between ST-segment resolution and anterior infarct size after primary percutaneous coronary intervention: analysis from the INFUSE-AMI trial[J]. Eur Heart J Acute Cardiovasc Care, 2014, 3(1): 78-83. DOI: 10.1177/2048872613508658.
[26]
TOPAL D G, LØNBORG J, AHTAROVSKI K A, et al. Association between early Q waves and reperfusion success in patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention: a cardiac magnetic resonance imaging study[J/OL]. Circ Cardiovasc Interv, 2017, 10(3): e004467 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/28264870/. DOI: 10.1161/CIRCINTERVENTIONS.116.004467.
[27]
CHEN Y Y, JIN H, GUAN X M, et al. Detecting hemorrhagic myocardial infarction with 3.0-T CMR: insights into spatial manifestation, time-dependence, and optimal acquisitions[J]. JACC Cardiovasc Imaging, 2025, 18(4): 436-447. DOI: 10.1016/j.jcmg.2024.10.006.
[28]
HE J, ZHAO S H, LU M J. Cardiac magnetic resonance feature tracking technique and its progress[J]. Chin J Magn Reson Imag, 2020, 11(6): 469-473. DOI: 10.12015/issn.1674-8034.2020.06.018.
[29]
ZHANG M, LI Z, WANG Y W, et al. Left atrial and ventricular longitudinal strain by cardiac magnetic resonance feature tracking improves prognostic stratification of patients with ST-segment elevation myocardial infarction[J]. Int J Cardiovasc Imaging, 2024, 40(9): 1881-1890. DOI: 10.1007/s10554-024-03174-z.
[30]
WANG J L, KONG Y, XI J N, et al. Recovery and prognostic values of myocardial strain in acute anterior and non-anterior wall myocardial infarction[J/OL]. PLoS One, 2023, 18(2): e0282027 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/36800349/. DOI: 10.1371/journal.pone.0282027.
[31]
KHAN J N, NAZIR S A, SINGH A, et al. Relationship of myocardial strain and markers of myocardial injury to predict segmental recovery after acute ST-segment-elevation myocardial infarction[J/OL]. Circ Cardiovasc Imaging, 2016, 9(6): e003457 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/27283007/. DOI: 10.1161/CIRCIMAGING.115.003457.
[32]
CHADALAVADA S, FUNG K, RAUSEO E, et al. Myocardial strain measured by cardiac magnetic resonance predicts cardiovascular morbidity and death[J]. J Am Coll Cardiol, 2024, 84(7): 648-659. DOI: 10.1016/j.jacc.2024.05.050.
[33]
POLACIN M, KAROLYI M, EBERHARD M, et al. Segmental strain analysis for the detection of chronic ischemic scars in non-contrast cardiac MRI cine images[J/OL]. Sci Rep, 2021, 11(1): 12376 [2025-06-05]. https://pubmed.ncbi.nlm.nih.gov/34117271/. DOI: 10.1038/s41598-021-90283-7.
[34]
ZHAO Y N, CUI J N, ZHANG X H, et al. Relationship of microvascular obstruction with global and regional myocardial function determined by cardiac magnetic resonance after ST-segment elevation myocardial infarction[J]. Chin Med Sci J, 2023, 38(1): 11-19. DOI: 10.24920/004120.

PREV Value of synthetic MRI based histogram features combined with short axis in diagnosis of lymph node metastasis in nasopharyngeal carcinoma
NEXT Differentiating non-mass breast cancer and non-lactational mastitis based on multi-parameter MRI radiomics
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn