Imaging of Clinically Unrecognized Myocardial Fibrosis in Patients With Suspected Coronary Artery Disease.
Imaging of Clinically Unrecognized Myocardial Fibrosis in Patients With Suspected Coronary Artery Disease.
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DOI：
10.1016/j.jacc.2020.06.063
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发表时间：
2020-08-25
影响因子：
24
通讯作者：
SPINS Study Investigators
中科院分区：
文献类型：
--
作者：
Antiochos P;Ge Y;Steel K;Bingham S;Abdullah S;Mikolich JR;Arai AE;Bandettini WP;Patel AR;Farzaneh-Far A;Heitner JF;Shenoy C;Leung SW;Gonzalez JA;Shah DJ;Raman SV;Ferrari VA;Schulz-Menger J;Stuber M;Simonetti OP;Kwong RY;SPINS Study Investigators
应激性心脏磁共振（CMR）提供准确的评估心肌梗死（MI）和缺血。本研究旨在评估在冠状动脉疾病（CAD）评估中通过应激CMR检测到的未识别心肌梗死（UMI）的增量预后价值，超出心功能和缺血。在多中心spin （Stress CMR Perfusion Imaging In the United States）研究中，2,349名疑似CAD的连续患者（63±11岁，53%为男性）接受应激CMR评估，随访时间中位数为5.4年。UMI被定义为在没有心肌梗死病史的情况下出现与心肌梗死一致的晚期钆增强。本研究调查了UMI与全因死亡率和非致死性心肌梗死（死亡和/或心肌梗死）以及主要心脏不良事件（MACE）的关系。347例（14.8%）患者检测到UMI， 358例（15.2%）患者临床诊断为心肌梗死（RMI）。与RMI患者相比，UMI患者的心血管危险因素负担相似，但左心室射血分数显著降低（p < 0.001），指南指导的药物治疗率也较低，包括阿司匹林（p < 0.001）、他汀类药物（p < 0.001）和受体阻滞剂（p = 0.002）。在随访期间，发生328例死亡和/或MIs， 528例MACE。在单因素分析中，UMI和RMI与死亡和/或MI密切相关（UMI：风险比[HR]: 2.15； 95%可信区间[CI]: 1.63至2.83;p < 0.001; RMI: HR: 2.45; 95% CI: 1.89至3.18）和MACE。与RMI患者相比，UMI患者出现心力衰竭住院的风险增加（UMI vs RMI: HR: 2.60; 95% CI: 1.48 ~ 4.58; p < 0.001）。在包括缺血和左心室射血分数在内的多变量模型中，UMI和RMI与死亡和/或MI （UMI: HR: 1.82; 95% CI: 1.37至2.42;p < 0.001; RMI: HR: 1.54; 95% CI: 1.14至2.09）和MACE保持着强大的预后关联。在一项疑似CAD患者的多中心队列研究中，存在UMI或RMI预示着同样显著的死亡和/或心肌梗死风险，独立于缺血的存在。与RMI患者相比，UMI患者接受指南指导的药物治疗的可能性较小，心力衰竭住院的风险增加，值得进一步研究。美国应力CMR灌注成像[SPINS]； NCT03192891)
Stress cardiac magnetic resonance (CMR) provides accurate assessment of both myocardial infarction (MI) and ischemia. This study aimed to evaluate the incremental prognostic value of unrecognized myocardial infarction (UMI), detected during assessment of coronary artery disease (CAD) by stress CMR, beyond cardiac function and ischemia. In the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, 2,349 consecutive patients (63 ± 11 years of age, 53% were male) with suspected CAD were assessed by stress CMR and followed over a median of 5.4 years. UMI was defined as the presence of late gadolinium enhancement consistent with MI in the absence of medical history of MI. This study investigated the association of UMI with all-cause mortality and nonfatal MI (death and/or MI), and major adverse cardiac events (MACE). UMI was detected in 347 patients (14.8%) and clinically recognized myocardial infarction (RMI) in 358 patients (15.2%). Compared with patients with RMI, patients with UMI had a similar burden of cardiovascular risk factors, but significantly lower left ventricular ejection fraction (p < 0.001) and lower rates of guideline-directed medical therapies, including aspirin (p < 0.001), statin (p < 0.001), and beta-blockers (p = 0.002). During follow-up, 328 deaths and/or MIs and 528 MACE occurred. In univariate analysis, UMI and RMI were strongly associated with death and/or MI (UMI: hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.63 to 2.83; p < 0.001; RMI: HR: 2.45; 95% CI: 1.89 to 3.18) and MACE. Compared with patients with RMI, patients with UMI presented an increased risk for heart failure hospitalization (UMI vs. RMI: HR: 2.60; 95% CI: 1.48 to 4.58; p < 0.001). In a multivariate model including ischemia and left ventricular ejection fraction, UMI and RMI maintained robust prognostic association with death and/or MI (UMI: HR: 1.82; 95% CI: 1.37 to 2.42; p < 0.001; RMI: HR: 1.54; 95% CI: 1.14 to 2.09) and MACE. In a multicenter cohort of patients with suspected CAD, presence of UMI or RMI portended an equally significant risk for death and/or MI, independently of the presence of ischemia. Compared with RMI patients, those with UMI were less likely to receive guideline-directed medical therapies and presented an increased risk for heart failure hospitalization that warrants further study. (Stress CMR Perfusion Imaging in the United States [SPINS]; NCT03192891).
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影响因子：
37.8
作者：
Kwong RY;Sattar H;Wu H;Vorobiof G;Gandla V;Steel K;Siu S;Brown KA
通讯作者：
Brown KA
影响因子：
3.5
作者：
Ohrn, Andrea Milde;Schirmer, Henrik;Lindekleiv, Haakon
通讯作者：
Lindekleiv, Haakon
影响因子：
19.7
作者：
Barbier, Charlotte Ebeling;Bjerner, Tomas;Ahlstroem, Hakan
通讯作者：
Ahlstroem, Hakan
影响因子：
5.4
作者：
McAreavey D;Vidal JS;Aspelund T;Eiriksdottir G;Schelbert EB;Kjartansson O;Cao JJ;Thorgeirsson G;Sigurdsson S;Garcia M;Harris TB;Launer LJ;Gudnason V;Arai AE
通讯作者：
Arai AE
DOI：
10.1016/s0735-1097(99)00524-0
发表时间：
2000-01-01
影响因子：
24
作者：
Sheifer, SE;Gersh, BJ;Manolio, TA
通讯作者：
Manolio, TA