Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain.
Clínica Creu Blanca, Barcelona, Spain.
Eur Radiol. 2019 May;29(5):2263-2271. doi: 10.1007/s00330-018-5774-7. Epub 2018 Nov 7.
Cardiovascular magnetic resonance (CMR) provides information on myocardial ischemia through stress perfusion studies. In clinical practice, the grading of induced perfusion defects is performed by visual estimation of their extension. The aim of our study is to devise a score of the degree of ischemia and to test its prognostic value.
Between 2009 and 2011, patients with diagnosed or suspected coronary artery disease underwent stress perfusion CMR. A score of ischemic burden was calculated on the basis of (1) stress-induced perfusion defect, (2) persistence, (3) transmurality, and (4) stress-induced contractile defect. Follow-up was censored after 4 years and primary end-point was defined by a composite of death, heart failure episode, acute coronary syndrome, and ventricular arrhythmias. Univariate and multivariate logistic regressions were used to assess the strength of the association between the CMR ischemic variables, and the composite outcome.
Forty-four of the 128 patients (34%) presented with adverse events, while 84 (66%) did not. Sixty-one patients (48%) had negative perfusion studies while 67 (52%) showed perfusion defect. Patients with positive perfusion studies and adverse events (n = 39) had higher number of segments with persistent defect (3.3 vs 1.3, p = 0.001) and highest score (19.6 vs 13.3 p = 0.012) than patients with positive perfusion studies and absence of events (n = 28). The number of segments with persistent defect showed the strongest predictive value of adverse events (OR 1.54; CI 1.19-2.00; p < 0.001).
The score of ischemic burden proposed herein has prognostic value. Persistence of a perfusion defect has the strongest impact on prognosis.
• Cardiovascular magnetic resonance provides information on myocardial ischemia by visual estimation of the presence of perfusion defects induced by stress. • There is not a standardized method for grading perfusion defects which, in practice, is performed by visual estimation of their extension. • As proven in this study, the integration of several parameters of perfusion defects (in addition to extension) into a semiquantitative score has prognostic value.
心血管磁共振（CMR）通过负荷灌注研究提供心肌缺血信息。在临床实践中，通过目测诱导的灌注缺损的程度来对其进行分级。我们研究的目的是设计一个缺血程度评分，并检验其预后价值。
2009 年至 2011 年间，诊断或疑似冠心病的患者接受了负荷灌注 CMR 检查。根据（1）应激诱导的灌注缺损、（2）持续存在、（3）透壁性和（4）应激诱导的收缩功能障碍，计算缺血负荷评分。随访截止至 4 年后，主要终点定义为死亡、心力衰竭发作、急性冠状动脉综合征和室性心律失常的复合终点。使用单变量和多变量逻辑回归来评估 CMR 缺血变量与复合结局之间的关联强度。
128 例患者中（34%）44 例（44%）出现不良事件，84 例（66%）未出现。61 例（48%）患者灌注研究阴性，67 例（52%）患者显示灌注缺损。阳性灌注研究且发生不良事件的患者（n=39）持续存在的缺损节段数（3.3 比 1.3，p=0.001）和最高评分（19.6 比 13.3，p=0.012）均高于阳性灌注研究且无事件的患者（n=28）。持续存在的缺损节段数对不良事件具有最强的预测价值（OR 1.54；95%CI 1.19-2.00；p<0.001）。
本研究提出的缺血负荷评分具有预后价值。灌注缺损的持续存在对预后的影响最大。
心血管磁共振通过目测应激诱导的灌注缺陷的存在来提供心肌缺血信息。
目前尚无分级灌注缺陷的标准化方法，实际上是通过目测其延伸程度来进行分级。
正如本研究证明的那样，将灌注缺陷的几个参数（除了延伸程度）整合到一个半定量评分中具有预后价值。
