在疑似或已知冠状动脉疾病患者中,双嘧达莫应激冠状动脉造影显示的诱导性室壁运动异常不具有长期增量预后价值。

IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
European Radiology Pub Date : 2025-03-01 Epub Date: 2024-11-28 DOI:10.1007/s00330-024-11229-x
Antonella Meloni, Cinzia Nugara, Antonio De Luca, Camilla Cavallaro, Chiara Cappelletto, Andrea Barison, Giancarlo Todiere, Chrysanthos Grigoratos, Sophie Mavrogeni, Giuseppina Novo, Francesco Grigioni, Michele Emdin, Gianfranco Sinagra, Emilio Quaia, Filippo Cademartiri, Alessia Pepe
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引用次数: 0

摘要

研究目的这项单中心回顾性研究评估了已知或疑似冠状动脉疾病(CAD)患者接受双嘧达莫负荷心脏磁共振(CMR)检查的长期(约 5 年)预后价值,评估了缺血级联的两个关键阶段(灌注和室壁运动)的影响:我们对 322 名连续接受双嘧达莫负荷 CMR 的患者进行了研究。我们分析了静息时和双嘧达莫后的异常室壁运动、应激时和静息时的灌注以及晚期钆增强(LGE)。终点是非致死性心肌梗死、非计划性晚期血管再通(CMR 后 60 天)和心源性死亡:44名患者因接受了早期血管再通手术(应激CMR检查后60天内)而被排除在外,最终共有278名患者(73名女性,62.42 ± 10.50岁)接受了应激CMR检查。78名患者(28.1%)的应激CMR结果呈阳性;50名患者至少有一个心肌节段存在可逆的应激灌注缺损,28名患者存在可逆的应激灌注缺损,而且与其他患者相比,应激室壁运动有所恶化。在平均 59.34 ± 31.72 个月的随访期间,共记录到 37 例(13.3%)心脏事件:10 例心源性死亡,1 例非致死性心肌梗死,26 例因不稳定型心绞痛或心肌梗死而进行的后期血管重建。根据 Cox 回归分析,年龄、糖尿病、既往血管再通、左室射血分数(LVEF)、可逆灌注和灌注+运动缺损以及 LGE 是重要的单变量预后指标。与仅有灌注缺损相比,伴有室壁运动异常(WMA)并不能提供额外的预后分层。在多变量 Cox 回归中,独立的预测因素是糖尿病(危险比值-HR = 5.64,p 结论:糖尿病是预后的关键因素):双嘧达莫应激CMR阳性预示着较高的心血管事件长期风险,但与可逆性灌注缺损相比,诱导性WMA的存在并未显示出任何额外的预后价值:问题 对已知或疑似有 CAD 的患者进行负荷心脏磁共振检查,诱导性室壁运动异常的长期增量预后价值需要研究。研究结果 与唯一的可逆性灌注缺损相比,诱导性室壁运动异常并不提供额外的预后价值。临床意义 独立于室壁运动异常的存在,对于存在可逆性灌注缺陷的患者,可能应该采取更积极的治疗措施,以降低心血管事件的长期风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Absence of long-term incremental prognostic value of inducible wall motion abnormalities on dipyridamole stress CMR in patients with suspected or known coronary artery disease.

Objectives: This single-center retrospective study evaluated the long-term (~5 years) prognostic value of dipyridamole stress cardiac magnetic resonance (CMR) in patients with known or suspected coronary artery disease (CAD), assessing the impact of both key phases of the ischemic cascade (perfusion and wall motion).

Material and methods: We considered 322 consecutive patients who underwent dipyridamole stress CMR. Abnormal wall motion at rest and after dipyridamole, perfusion at stress and at rest, and late gadolinium enhancement (LGE) were analyzed. End-points were non-fatal myocardial infarction, unplanned late revascularization (60 days after CMR), and cardiac death.

Results: Forty-four patients were excluded because they underwent early revascularization (within 60 days after stress CMR), leading to a final population of 278 patients (73 females, 62.42 ± 10.50 years). A positive stress CMR was found in 78 (28.1%) patients; 50 patients had a reversible stress perfusion defect in at least one myocardial segment and 28 had a reversible stress perfusion defect plus worsening of stress wall motion in comparison with the rest. During a mean follow-up time of 59.34 ± 31.72 months, 37 (13.3%) cardiac events were recorded: 10 cardiac deaths, one non-fatal myocardial infarction, and 26 late revascularization after unstable angina or myocardial infarction. According to the Cox regression analysis, age, diabetes mellitus, previous revascularization, left ventricular ejection fraction (LVEF), reversible perfusion and perfusion + motion defect, and LGE were significant univariate prognosticators. The presence of associated wall motion abnormality (WMA) did not provide additional prognostic stratification in comparison to the only perfusion defect. In the multivariate Cox regression, the independent predictive factors were diabetes (hazard-ratio-HR = 5.64, p < 0.0001), reversible perfusion defect and reversible perfusion + motion defect vs normal stress CMR (HR = 6.43, p < 0.0001, and HR = 4.57, p = 0.004; respectively), and LVEF (HR = 0.96, p = 0.010).

Conclusion: A positive dipyridamole stress CMR predicted a higher long-term risk of cardiovascular events, but the presence of inducible WMA did not show any additional prognostic value over the reversible perfusion defect.

Key points: Question The long-term incremental prognostic value of inducible wall motion abnormalities by stress cardiac MR in patients with known or suspected CAD requires investigation. Findings The presence of inducible wall motion abnormalities did not offer additional prognostic value in comparison to the only reversible perfusion defect. Clinical relevance Independent from the presence of wall motion abnormalities, more aggressive management may be appropriate in patients with reversible perfusion defects to reduce the long-term risk of cardiovascular events.

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来源期刊
European Radiology
European Radiology 医学-核医学
CiteScore
11.60
自引率
8.50%
发文量
874
审稿时长
2-4 weeks
期刊介绍: European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.
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