Department of Internal Medicine II, University of Ulm, Ulm, Germany.
JACC Cardiovasc Imaging. 2013 Jan;6(1):56-63. doi: 10.1016/j.jcmg.2012.08.011.
The aim of this study was to assess the hypothesis that cardiac magnetic resonance (CMR) myocardial perfusion imaging can provide incremental prognostic value over other risk factors regarding the prediction of major cardiovascular events in a large, consecutive, and thereby unselected population of patients presenting with stable angina pectoris.
Recently, it has been shown that CMR provides good short-term prognosis in patients with stable coronary heart disease. Reversible myocardial ischemia can be assessed using a combination of perfusion and late gadolinium enhancement imaging. Data concerning intermediate-term prognostic information, especially on major clinical endpoints such as cardiac death or myocardial infarction, are limited.
From 2003 to 2007, consecutive patients with stable angina pectoris who underwent adenosine perfusion CMR were enrolled unless they met the predefined exclusion criteria. Myocardial perfusion imaging by adenosine stress and late gadolinium enhancement was assessed using a 1.5-T whole-body CMR scanner. Follow-up information concerning the combined endpoint of cardiac death, nonfatal myocardial infarction, and stroke was obtained from patients, general practitioners, or treating hospitals, respectively.
In our study, 1,229 consecutive patients were enrolled. The mean follow-up period was 4.2 ± 2.1 years. During this time, 88 primary endpoints occurred. In patients with reversible perfusion deficits, significantly more cardiac deaths (p < 0.0001) and nonfatal myocardial infarctions (p = 0.001) were observed than in the control group. On multivariate analysis, reversible perfusion deficit was the strongest independent predictor for an event, with a 3-fold increased risk. Moreover, the absence of a perfusion deficit was shown to exhibit high negative predictive value.
Adenosine perfusion CMR provides excellent risk stratification and intermediate-term prognostic value in patients with stable coronary artery disease. The presence of a myocardial perfusion deficit is an incremental prognostic risk factor over other risk factors.
本研究旨在验证一个假设，即在一个大型、连续且未经选择的稳定型心绞痛患者人群中，心脏磁共振（CMR）心肌灌注成像在预测主要心血管事件方面可以提供比其他危险因素更多的预后价值。
最近，CMR 已被证明可以为稳定型冠心病患者提供良好的短期预后。可以通过灌注和晚期钆增强成像的组合来评估可逆性心肌缺血。关于中期预后信息的数据，特别是关于心脏死亡或心肌梗死等主要临床终点的信息，是有限的。
2003 年至 2007 年，连续入组接受腺苷负荷 CMR 检查的稳定型心绞痛患者，除非符合预先设定的排除标准。采用 1.5T 全身 CMR 扫描仪评估腺苷负荷和晚期钆增强的心肌灌注成像。通过患者、全科医生或治疗医院分别获得关于心脏死亡、非致死性心肌梗死和中风联合终点的随访信息。
在我们的研究中，连续入组了 1229 例患者。平均随访时间为 4.2±2.1 年。在此期间，88 例主要终点事件发生。在有可逆性灌注缺损的患者中，观察到的心脏死亡（p<0.0001）和非致死性心肌梗死（p=0.001）明显更多。多变量分析显示，可逆性灌注缺损是事件发生的最强独立预测因素，风险增加了 3 倍。此外，不存在灌注缺损显示出高阴性预测值。
腺苷负荷 CMR 为稳定型冠状动脉疾病患者提供了出色的风险分层和中期预后价值。存在心肌灌注缺损是比其他危险因素更具预后价值的附加危险因素。
