Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial.

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2024-12-01 Epub Date: 2024-12-17 DOI:10.1161/CIRCINTERVENTIONS.123.013743

Harmony R Reynolds, Courtney B Page, Leslee J Shaw, Daniel S Berman, Bernard R Chaitman, Michael H Picard, Raymond Y Kwong, James K Min, Jonathon Leipsic, G B John Mancini, Matthew J Budoff, Cameron J Hague, Roxy Senior, Hanna Szwed, Balram Bhargava, Jelena Celutkiene, Milind Gadkari, Kevin R Bainey, Rolf Doerr, Ruben B Ramos, Peter Ong, Sudhir R Naik, Philippe Gabriel Steg, Kaatje Goetschalckx, Benjamin J W Chow, Marielle Scherrer-Crosbie, Lawrence Phillips, Daniel B Mark, John A Spertus, Karen P Alexander, Sean M O'Brien, William E Boden, Sripal Bangalore, Gregg W Stone, David J Maron, Judith S Hochman

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引用次数: 0

Abstract

Background: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.

Methods: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test. Among those with preserved renal function who underwent coronary computed tomography angiography, we examined relationships between ischemia and CAD by coronary computed tomography angiography, overall, and by stress test modality, regardless of subsequent randomization. Core laboratories categorized ischemia as severe, moderate, mild, or none, while the extent and severity of anatomic CAD were categorized based on the modified Duke prognostic index.

Results: Among 3601 participants with interpretable stress tests and coronary computed tomography angiography, ischemia severity was weakly associated with CAD extent/severity (r=0.27), with modest variability in strength of association by modality: nuclear (n=1532; r=0.40), echocardiography (n=827; r=0.15), cardiac magnetic resonance imaging (n=108; r=0.31), and exercise tolerance test (n=1134; r=0.18). The extent of infarction on nuclear imaging and echocardiography was weakly associated with CAD extent/severity.

Conclusions: Overall, ischemia severity on stress testing showed weak to moderate associations with the anatomic extent of CAD in this cohort with moderate or severe ischemia on local interpretation and controlled symptoms.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

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缺血试验中不同应激试验方式下缺血严重程度与冠状动脉疾病的关系

背景：阻塞性冠心病患者应激性缺血的程度和严重程度与解剖性冠状动脉疾病（CAD）的程度和严重程度之间的关系是多因素的，包括应激强度、使用的检测类型、先前梗死的存在和程度、侧支血流量、斑块特征、微血管疾病、冠状动脉血管舒张性和遗传因素。在有中度或重度缺血的慢性冠状动脉疾病参与者中，我们研究了应激测试中缺血严重程度与冠状动脉计算机断层血管造影中CAD程度之间的关系。方法：临床指示的压力测试包括核成像、超声心动图、心脏磁共振成像或非成像运动耐量试验。在接受冠状动脉计算机断层血管造影的肾功能保存者中，我们通过冠状动脉计算机断层血管造影检查了缺血和CAD之间的关系，总体上，通过压力测试方式，无论随后的随机化。核心实验室将缺血分为严重、中度、轻度或无，而解剖性CAD的程度和严重程度则根据修改后的Duke预后指数进行分类。结果：在3601名可解释的压力测试和冠状动脉计算机断层扫描血管造影的参与者中，缺血严重程度与CAD程度/严重程度弱相关（r=0.27），在模式上的关联强度有适度的变化：核(n=1532；R =0.40)，超声心动图(n=827；R =0.15)，心脏磁共振成像(n=108；R =0.31)，运动耐量试验(n=1134；r = 0.18)。核成像和超声心动图显示梗死范围与冠心病程度/严重程度呈弱相关。结论：总体而言，应激测试中的缺血严重程度与CAD的解剖程度呈弱至中度相关性，局部解释和控制症状为中度或重度缺血。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT01471522。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.