Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry.
Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry.
复制标题
疑似缺血性心脏病的性别特异性应激灌注心脏磁共振成像：来自 SPINS 回顾性登记的见解。
DOI：
10.1016/j.jcmg.2022.11.025
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Shenoy,Ch
中科院分区：
文献类型：
--
作者：
Heydari,Bobak;Ge,Yin;Antiochos,Panagiotis;Islam,Sabeeh;Steel,Kevin;Bingham,Scott;Abdullah,Shuaib;Mikolich,JRonald;Arai,AndrewE;Bandettini,WPatricia;Patel,AmitR;Shanbhag,SujataM;Farzaneh-Far,Afshin;Heitner,JohnF;Shenoy,Ch
背景 心血管疾病（CVD）仍然是女性死亡的主要原因，但目前的无创心脏成像技术存在性别特异性的局限性。目的 在本研究中，作者试图探讨性别对可疑 CVD 的预后效用、下游侵入性血运重建以及负荷灌注心脏磁共振 (CMR) 成本的影响。方法 在一项包含 2,349 名患者的多中心 SPINS（美国 SPINS 研究中的应力 CMR 灌注成像）登记中评估性别特异性预后表现。主要结局指标是心血管死亡和非致命性心肌梗死的综合指标；次要结局是因不稳定心绞痛或心力衰竭住院，以及晚期计划外冠状动脉旁路移植术。结果 SPINS 纳入了 1,104 名女性（占队列的 47%）；女性胸痛患病率较高（62% vs 50%；P<0.0001），但药物治疗的使用率较低。在 5.4 年的中位随访中，压力 CMR 正常的女性的主要综合结果年化率较低，与男性相似（分别为 0.54%/年 vs 0.75%/年；P= NS）。相反，与 CMR 正常的女性相比，CMR 异常的女性主要（3.74%/年 vs 0.54%/y；P<0.0001）和次要（9.8%/y vs 1.6%/y；P<0.0001）结局的风险均较高。异常应激 CMR 是主要（HR：2.64 95% CI：1.20-5.90；P = 0.02）和次要（HR：2.09 95% CI：1.43-3.08；P < 0.0001）结果测量的独立预测因子。性别没有效果修改。 CMR 后 90 天，女性的侵入性冠状动脉造影率（3.6% vs 7.3%；P=0.0001）和下游成本（114vs 171；P=0.001）较低。性别对诊断图像质量没有影响。结论 压力 CMR 显示出良好的预后性能，且女性接受侵入性冠状动脉造影转诊的比率较低。应力CMR应被视为评估女性的一线无创影像工具。（美国SPINS研究SPINS中的应力CMR灌注成像；NCT03192891）
Background Cardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations. Objectives In this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD. Methods Sex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States SPINS Study) Registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting. Results SPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P< 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P= NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P< 0.0001) and secondary (9.8%/y vs 1.6%/y; P< 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 95% CI: 1.20-5.90; P= 0.02) and secondary (HR: 2.09 95% CI: 1.43-3.08; P< 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (3.6% vs 7.3%; P= 0.0001) and downstream costs (114vs 171; P= 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality. Conclusions Stress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women.(Stress CMR Perfusion Imaging in the United States SPINS Study SPINS; NCT03192891)