Incremental value of normal adenosine perfusion cardiac magnetic resonance: Long-term outcome
Incremental value of normal adenosine perfusion cardiac magnetic resonance: Long-term outcome
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DOI：
10.1016/j.ahj.2015.03.001
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发表时间：
2015-06-01
影响因子：
4.8
通讯作者：
Dor, Vincent
中科院分区：
文献类型：
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作者：
Sozzi, Fabiola B.;Iacuzio, Laura;Dor, Vincent
背景本研究的目的是确定正常腺苷负荷心脏磁共振成像（CMR）的长期预后价值的患者参考心肌ischemia.Methods评价我们回顾了连续300例（年龄65 +/- 11岁，74%男性）可疑或已知的冠状动脉疾病和正常室壁运动谁经历了腺苷负荷CMR阴性缺血和疤痕。大多数患者处于冠状动脉疾病的中等风险。研究终点为所有死亡原因和主要不良心脏事件，包括心源性死亡、心肌梗死、血运重建和因不稳定型心绞痛住院治疗。结果平均随访5.5年（平均5.4 ± 1.1年），16例患者死于各种原因（心源性死亡5例）。3例患者发生非致死性心肌梗死，7例患者住院接受血运重建，11例患者接受不稳定型心绞痛药物治疗。心脏事件年发生率为1.3%（前3年为0.78%，第4年至第6年为1.9%）。多变量分析模型中主要不良心脏事件的预测因素如下：高龄（风险比[HR] 1.15，95%置信区间[95%CI] 1.02-1.30）、糖尿病（HR 17.5，95%CI 2.2-140）和吸烟习惯（HR 5.9，95%CI 1.0-35.5）。对于所有死亡原因，唯一的预测因素是糖尿病（HR 11.4，95% CI 1.76-74.2）。正常压力CMR患者在研究后3年内结局良好。结论腺苷负荷正常的CMR患者在5.5年内心脏事件发生率低，预后良好。CMR正常的低至中等风险患者发生后续心脏事件的风险较低。
Background The purpose of the study was to determine the long-term prognostic value of normal adenosine stress cardiac magnetic resonance imaging (CMR) in patients referred for evaluation of myocardial ischemia.Methods We reviewed 300 consecutive patients (age 65 +/- 11 years, 74% male) with suspected or known coronary disease and normal wall motion who had undergone adenosine stress CMR negative for ischemia and scar. Most patients were at intermediate risk of coronary artery disease. The end points studied were all causes of mortality and major adverse cardiac events, including cardiac death, myocardial infarction, revascularization, and hospitalization for unstable angina.Results During amean follow-up of 5.5 years (mean = 5.4 +/- 1.1), 16 patients died because of various causes (cardiac death in 5 patients). Three patients had a nonfatal myocardial infarction, 7 patients were hospitalized for revascularization, and 11 were medically treated for unstable angina. The annual cardiac event rate was 1.3% (0.78% in the first 3 years and 1.9% between the fourth and sixth years). The predictors of major adverse cardiac events in a multivariate analysis model were as follows: advanced age (hazard ratio [HR] 1.15, 95% confidence interval [95% CI] 1.02-1.30), diabetes (HR 17.5, 95% CI 2.2-140), and the habit of smoking (HR 5.9, 95% CI 1.0-35.5). For all causes of mortality, the only predictor was diabetes (HR 11.4, 95% CI 1.76-74.2). Patients with normal stress CMR had an excellent outcome during the 3 years after the study. The cardiac event rate was higher between the fourth and sixth years.Conclusion Over a 5.5-year period, a low event rate and excellent prognosis occurred in patients with normal adenosine stress CMR. Low-to intermediate-risk patients with a normal CMR are at low risk for subsequent cardiac events.