心血管磁共振应力灌注测试在女性冠心病检测中的价值

Value of cardiovascular magnetic resonance stress perfusion testing for the detection of coronary artery disease in women.

作者信息

Klem Igor, Greulich Simon, Heitner John F, Kim Han, Vogelsberg Holger, Kispert Eva-Maria, Ambati Srivani R, Bruch Christian, Parker Michele, Judd Robert M, Kim Raymond J, Sechtem Udo

机构信息

Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina 27710, USA.

出版信息

JACC Cardiovasc Imaging. 2008 Jul;1(4):436-45. doi: 10.1016/j.jcmg.2008.03.010.

DOI:10.1016/j.jcmg.2008.03.010

PMID:19356464

Abstract

OBJECTIVES

We wanted to assess the value of cardiovascular magnetic resonance (CMR) stress testing for evaluation of women with suspected coronary artery disease (CAD).

BACKGROUND

A combined perfusion and infarction CMR examination can accurately diagnose CAD in the clinical setting in a mixed gender population.

METHODS

We prospectively enrolled 147 consecutive women with chest pain or other symptoms suggestive of CAD at 2 centers (Duke University Medical Center, Robert-Bosch-Krankenhaus). Each patient underwent a comprehensive clinical evaluation, a CMR stress test consisting of cine rest function, adenosine-stress and rest perfusion, and delayed-enhancement CMR infarction imaging, and X-ray coronary angiography within 24 h. The components of the CMR test were analyzed visually both in isolation and combined using a pre-specified algorithm. Coronary artery disease was defined as stenosis > or =70% on quantitative analysis of coronary angiography.

RESULTS

Cardiovascular magnetic resonance imaging was completed in 136 females (63.0 +/- 11.1 years), 37 (27%) women had CAD on coronary angiography. The combined CMR stress test had a sensitivity, specificity, and accuracy of 84%, 88%, and 87%, respectively, for the diagnosis of CAD. Diagnostic accuracy was high at both sites (Duke University Medical Center 82%, Robert-Bosch-Krankenhaus 90%; p = 0.18). The accuracy for the detection of CAD was reduced when intermediate grade stenoses were included (82% vs. 87%; p = 0.01 compared the cutoff of stenosis > or =50% vs. > or =70%). The sensitivity was lower in women with single-vessel disease (71% vs. 100%; p = 0.06 compared with multivessel disease) and small left ventricular mass (69% vs. 95%; p = 0.04 for left ventricular mass < or =97 g vs. >97 g). The latter difference was even more significant after accounting for end-diastolic volumes (70% vs. 100%; p = 0.02 for left ventricular mass indexed to end-diastolic volume < or =1.15 g/ml vs. >1.15 g/ml).

CONCLUSIONS

A multicomponent CMR stress test can accurately diagnose CAD in women. Detection of CAD in women with intermediate grade stenosis, single-vessel disease, and with small hearts is challenging.

摘要

目的

我们旨在评估心血管磁共振（CMR）负荷试验对疑似冠心病（CAD）女性患者的评估价值。

背景

灌注与梗死联合CMR检查能够在临床环境中准确诊断混合性别群体中的CAD。

方法

我们前瞻性地纳入了2个中心（杜克大学医学中心、罗伯特 - 博世医院）连续的147例有胸痛或其他提示CAD症状的女性患者。每位患者均接受了全面的临床评估、CMR负荷试验，包括电影静息功能、腺苷负荷及静息灌注以及延迟强化CMR梗死成像，并在24小时内进行了X线冠状动脉造影。CMR检查的各个组成部分分别及联合使用预先指定的算法进行视觉分析。冠状动脉疾病定义为冠状动脉造影定量分析显示狭窄≥70%。

结果

136名女性（63.0±11.1岁）完成了心血管磁共振成像，37名（27%）女性冠状动脉造影显示患有CAD。联合CMR负荷试验对CAD诊断的敏感性、特异性和准确性分别为84%、88%和87%。两个中心的诊断准确性均较高（杜克大学医学中心82%，罗伯特 - 博世医院90%；p = 0.18）。当纳入中度狭窄时，CAD检测的准确性降低（82%对87%；与狭窄≥50%对比狭窄≥）。单支血管病变女性的敏感性较低（71%对100%；与多支血管病变相比，p = 0.06），左心室质量较小的女性敏感性也较低（69%对95%；左心室质量≤97 g对比＞97 g，p = 0.04）。在考虑舒张末期容积后，后者的差异更为显著（70%对100%；左心室质量指数与舒张末期容积≤1.15 g/ml对比＞1.15 g/ml，p = 0.02）。