Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
J Womens Health (Larchmt). 2013 Feb;22(2):173-83. doi: 10.1089/jwh.2012.3714.
This multisite prospective trial, Stress Echocardiography in Menopausal Women At Risk for Coronary Artery Disease (SMART), aimed to evaluate the prognostic value of contrast stress echocardiography (CSE), coronary artery calcification (CAC), and cardiac biomarkers for prediction of cardiovascular events after 2 and 5 years in early menopausal women experiencing chest pain symptoms or risk factors. This report describes the study design, population, and initial test results at study entry.
From January 2004 through September 2007, 366 early menopausal women (age 54±5 years, Framingham risk score 6.51%±4.4 %, range 1%-27%) referred for stress echocardiography were prospectively enrolled. Image quality was enhanced with an ultrasound contrast agent. Tests for cardiac biomarkers [high-sensitivity C-reactive protein (hsCRP), atrial natriuretic protein (ANP), brain natriuretic protein (BNP), endothelin (ET-1)] and cardiac computed tomography (CT) for CAC were performed.
CSE (76% exercise, 24% dobutamine) was abnormal in 42 women (11.5%), and stress electrocardiogram (ECG) was positive in 22 women (6%). Rest BNP correlated weakly with stress wall motion score index (WMSI) (r=0.189, p<0.001). Neither hsCRP, ANP, endothelin, nor CAC correlated with stress WMSI. Predictors of abnormal CSE were body mass index (BMI), diabetes mellitus, family history of premature coronary artery disease (CAD), and positive stress ECG. Twenty-four women underwent clinically indicated coronary angiography (CA); 5 had obstructive (≥50%), 15 had nonobstructive (10%-49%), and 4 had no epicardial CAD.
The SMART trial is designed to assess the prognostic value of CSE in early menopausal women. Independent predictors of positive CSE were BMI, diabetes mellitus, family history of premature CAD, and positive stress ECG. CAC scores and biomarkers (with the exception of rest BNP) were not correlated with CSE results. We await the follow-up data.
这项多中心前瞻性试验——绝经后女性冠心病风险的超声心动图应激试验（SMART）旨在评估对比超声心动图应激试验（CSE）、冠状动脉钙化（CAC）和心脏生物标志物对绝经早期女性胸痛症状或危险因素后 2 年和 5 年心血管事件的预测价值。本报告介绍了研究设计、人群和入组时的初始检测结果。
从 2004 年 1 月至 2007 年 9 月，前瞻性纳入了 366 名绝经早期女性（年龄 54±5 岁，弗雷明汉风险评分 6.51%±4.4%，范围 1%-27%）进行超声心动图应激试验。使用超声造影剂增强图像质量。检测心脏生物标志物[高敏 C 反应蛋白（hsCRP）、心房利钠肽（ANP）、脑利钠肽（BNP）、内皮素（ET-1）]和心脏计算机断层扫描（CT）的 CAC。
42 名女性（11.5%）的 CSE（76%运动，24%多巴酚丁胺）异常，22 名女性（6%）的应激心电图（ECG）阳性。静息 BNP 与应激壁运动评分指数（WMSI）弱相关（r=0.189，p<0.001）。hsCRP、ANP、内皮素或 CAC 均与应激 WMSI 无关。CSE 异常的预测因子为体重指数（BMI）、糖尿病、早发冠心病家族史和阳性应激 ECG。24 名女性进行了临床指征的冠状动脉造影（CA）检查；5 例存在阻塞性病变（≥50%），15 例存在非阻塞性病变（10%-49%），4 例无外膜 CAD。
SMART 试验旨在评估 CSE 在绝经早期女性中的预测价值。CSE 阳性的独立预测因子为 BMI、糖尿病、早发 CAD 家族史和阳性应激 ECG。CAC 评分和生物标志物（除静息 BNP 外）与 CSE 结果无关。我们正在等待随访数据。
