Study On New Plasma And Radiomics Markers For Poor Prognosis Of Acute St-segment Elevation Myocardial Infarction

Obsjective: The identification of patients with a high likelihood of left ventricular(LV)remodeling with a high-risk prognosis has critical implications for risk stratification after acute ST-segment elevation myocardial infarction(STEMI).This study aimed to evaluate the relationship between circulating mi R-1 and 6-month post-infarct LV remodeling based on cardiac magnetic resonance(CMR)imaging.This study was conducted to further establish and validate a non-contrast T1 map-based radiomic nomogram for predicting major adverse cardiac events(MACEs)in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods: A total of 80 patients with a first STEMI treated with primary percutaneous coronary intervention(PCI)who underwent CMR imaging 1 week and 6 months after STEMI were evaluated.The percentage changes of LV ejection fraction(LVEF),LV enddiastolic volume(LVEDV),LV end-systolic volume index(LVESV)at 1 week and 6months after PCI(%?LVEF,%?LVEDV and %?LVESV)were calculated.mi R-1 was measured using polymerase chain reaction(PCR)-based technologies in plasma samples that were collected at admission.The study group of the second part was divided into two groups based on a 10% cutoff value for the percentage of change in the LV end-diastolic volume(%?LVEDV): remodeling at high risk of major adverse cardiac events(MACEs)(%?LVEDV ? 10%,termed the LV remodeling group)and remodeling at lower risk of MACEs(%?LVEDV < 10%,termed the non-LV remodeling group).The associations of mi R-1 expression with the %?LVEDV,percentage change in the LV end-systolic volume(%?LVESV),and percentage change in the LV ejection fraction at follow-up were estimated.This retrospective study included 157 consecutive patients(training sets,109patients;test sets,48 patients)with acute STEMI undergoing PCI.An open-source radiomics software was used to segment the myocardium on the non-contrast T1 mapping and extract features.A radiomic signature was constructed to predict MACEs using the least absolute shrinkage and selection operator method.The performance of the radiomic nomogram for predicting MACEs in both the training and test sets was evaluated by its discrimination,calibration,and clinical usefulness.Results: Twenty-two patients(27.5%)showed adverse LV remodeling,and 58 patients(72.5%)did not show adverse LV remodeling at the 6-month follow-up of CMR.The mean LVEF,LVEDV index,and LVESV index values at 1 week were 50.6% ± 8.2%,74.6 ± 12.8ml/m2,and 37.2 ± 10.2 ml/m2,respectively.Mean LVEF at follow-up(53.5% ± 10.6%)was increased compared with baseline(p < 0.001).There were significant decreases in LVEDV index and LVESV index values at follow-up(72.0 ± 14.9 ml/m2 and 33.7 ± 11.0ml/m2,respectively;p = 0.009 and p < 0.001,respectively).The expression of mi R-1 at admission was positively correlated with the %?LVEDV(r = 0.611,p < 0.001)and %?LVESV(r = 0.268,p = 0.016).Receiver operating characteristic(ROC)analysis showed that mi R-1 expression predicted LV remodeling with an area under the curve(AUC)value of 0.68(95%CI: 0.56–0.78).Compared with the clinical factors of peak creatine kinase–myocardial band(CK–MB)and peak troponin T level,peak log NT-pro BNP showed the highest predictive power,with an AUC value of 0.75(95%CI: 0.64–0.84).A model including the clinical,CMR,and mi R-1 factors showed greater predictive power(p= 0.034)than a model including only clinical and CMR factors,with AUCs of 0.89(95%CI:0.80–0.95)and 0.81(95%CI: 0.71–0.89),respectively.The radiomic signature showed a good prognostic ability in the training sets with an AUC of 0.94(95% CI,0.86 to 1.00)and F1 score of 0.71,which was confirmed in the test sets with an AUC of 0.90(95% CI,0.74 to 1.00)and F1 score of 0.62.The nomogram consisting of the radiomic scores and cardiac troponin I showed good discrimination ability in the training and test sets with AUCs of0.96(95% CI,0.91 to 1.00;F1 score,0.71)and 0.94(95% CI,0.83 to 1.00;F1 score,0.70),respectively.Conclusions: Circulating mi R-1 at admission is an independent predictor of LV remodeling 6 months after STEMI.mi R-1 showed incremental value in predicting LV remodeling compared with the clinical and CMR measurements.The non-contrast T1 mapbased radiomic nomogram is a useful tool for the prediction of MACEs in patients with acute STEMI undergoing PCI that can assist clinicians for optimised risk stratification of individual patients.