多巴酚丁胺应激心血管磁共振对曾接受冠状动脉旁路移植术患者的安全性。

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Jannick Heins, Janek Salatzki, Anne Köhrer, Andreas Ochs, Lukas D Weberling, Hauke Hund, Evangelos Giannitsis, Norbert Frey, Dirk Loßnitzer, Florian André, Henning Steen
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引用次数: 0

摘要

背景和目的:冠状动脉旁路移植术(CABG)患者发生重大心脏不良事件(MACE)的风险较高。高剂量多巴酚丁胺应激心血管磁共振成像(DCMR)是检测血流动力学显著性冠状动脉疾病(CAD)的成熟技术。然而,目前还缺乏有关 CABG 患者 DCMR 安全性的数据。本研究旨在评估 DCMR 在 CABG 患者中的安全性:我们回顾性研究了 2008 年 11 月至 2018 年 7 月间接受 CABG 术后又接受 DCMR 的患者。分析了 DCMR 期间的副作用(定义为不良事件和轻微症状),并将其与 200 名年龄、性别和体重指数相匹配且未接受过 CABG 的 DCMR 患者进行了比较:结果:共发现 336 名患者(70±9 岁,85% 为男性)。有 35 名 CABG 患者(10%)和 18 名对照组患者(9%,P=0.595)发生了不良事件。收缩压(SBP)下降 >40mmHg (12 名患者)、非持续性室性心动过速(6 名患者)、SBP 升高 >200mmHg (5 名患者)、单形性室性早搏收缩(PVC)(2 名患者)、心动过速(2 名患者)、左束支传导阻滞(2 名患者)、左束支传导阻滞(2 名患者)、左束支传导阻滞(2 名患者)、左束支传导阻滞(2 名患者)、左束支传导阻滞(2 名患者)、左束支传导阻滞(2 名患者),以及心动过速性阵发性心房颤动、心动过缓、室上性心动过速、对偶/三联律和窦性心律失常(各 1 名患者)。此外,一名患者因心动过速性阵发性房颤和短暂性脑缺血发作而住院治疗。研究组中有 29 人(8.7%)因胸痛、呼吸困难、恶心、头晕、SBP 下降、心律失常、心动过速性阵发性心房颤动、单形 PVC 或非持续性室性心动过速而放弃检查。检查流产率与对照组相当(15 例(7.5%),P=0.631)。单变量逻辑回归分析显示,女性(OR 2.21,95% CI 1.2 - 4.3,p=0.017)和诱导性缺血(OR 3.50,95% CI 2.0 - 6.0,p结论:多巴酚丁胺应激CMR显示,与未接受过CABG手术的患者相比,曾接受过CABG手术的患者发生不良事件的几率并没有明显增加。女性性别和多巴酚丁胺诱发的心肌缺血与 DCMR 期间的副作用有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety of dobutamine stress cardiovascular magnetic resonance in patients with prior coronary artery bypass grafting.

Background and purpose: Patients with coronary artery bypass grafts (CABG) face an elevated risk of major adverse cardiac events (MACE). High-dose dobutamine stress cardiovascular magnetic resonance imaging (DCMR) is a well-established technique to detect hemodynamically significant coronary artery disease (CAD). However, there is a lack of data regarding the safety of DCMR in patients with CABG. This study aims to evaluate the safety of DCMR in patients with CABG.

Methods: We retrospectively studied patients after CABG who subsequently underwent DCMR between November 2008 and July 2018. Side effects, defined as adverse events and minor symptoms, during DCMR were analyzed and compared to 200 individuals matched for age, sex and BMI without prior CABG undergoing DCMR.

Results: 336 patients (70±9 years, 85% men) were identified. Adverse events occurred in 35 CABG patients (10%) and 18 controls (9%, p=0.595). A drop of systolic blood pressure (SBP) >40mmHg (12 patients), non-sustained ventricular tachycardia (6 patients), increase in SBP >200mmHg (5 patients), monomorphic premature ventricular contractions (PVC) (2 patients), bigeminy (2 patients), left bundle-branch block (2 patients), as well as tachycardiac paroxysmal atrial fibrillation, bradycardia, supraventricular tachycardia, couplets/triplets, and sinus arrhythmia in one patient each occurred in the study group. In addition, one patient was hospitalized due to tachycardiac paroxysmal atrial fibrillation and transient ischemic attack. 29 (8.7%) examinations in the study group were aborted because of either chest pain, dyspnea, nausea, dizziness, a drop of SBP, arrhythmias, tachycardiac paroxysmal atrial fibrillation, monomorphic PVCs, or non-sustained ventricular tachycardia. The rate of aborted examination was comparable to the control group (15 (7.5%), p=0.631). Univariable logistic regression analysis revealed that female sex (OR 2.21, 95% CI 1.2 - 4.3, p=0.017) and inducible ischemia (OR 3.50, 95% CI 2.0 - 6.0, p<0.001) were associated with an increased risk of side effects during DCMR.

Conclusion: Dobutamine stress CMR did not show a relevant increase of adverse events in patients with prior CABG compared to patients without prior CABG. Female sex and dobutamine-induced myocardial ischemia are associated with side effects during DCMR.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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