New York Presbyterian Brooklyn Methodist Hospital, New York, New York.
Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.
JAMA Cardiol. 2019 Mar 1;4(3):256-264. doi: 10.1001/jamacardio.2019.0035.
Stress cardiac magnetic resonance imaging (CMR) is not widely used in current clinical practice, and its ability to predict patient mortality is unknown.
To determine whether stress CMR is associated with patient mortality.
DESIGN, SETTING, AND PARTICIPANTS: Real-world evidence from consecutive clinically ordered CMR examinations. Multicenter study of patients undergoing clinical evaluation of myocardial ischemia. Patients with known or suspected coronary artery disease (CAD) underwent clinical vasodilator stress CMR at 7 different hospitals. An automated process collected data from the finalized clinical reports, deidentified and aggregated the data, and assessed mortality using the US Social Security Death Index.
All-cause patient mortality.
Of the 9151 patients, the median (interquartile range) patient age was 63 (51-70) years, 55% were men, and the median (interquartile range) body mass index was 29 (25-33) (calculated as weight in kilograms divided by height in meters squared). The multicenter automated process yielded 9151 consecutive patients undergoing stress CMR, with 48 615 patient-years of follow-up. Of these patients, 4408 had a normal stress CMR examination, 4743 had an abnormal examination, and 1517 died during a median follow-up time of 5.0 years. Using multivariable analysis, addition of stress CMR improved prediction of mortality in 2 different risk models (model 1 hazard ratio [HR], 1.83; 95% CI, 1.63-2.06; P < .001; model 2: HR, 1.80; 95% CI, 1.60-2.03; P < .001) and also improved risk reclassification (net improvement: 11.4%; 95% CI, 7.3-13.6; P < .001). After adjustment for patient age, sex, and cardiac risk factors, Kaplan-Meier survival analysis showed a strong association between an abnormal stress CMR and mortality in all patients (HR, 1.883; 95% CI, 1.680-2.112; P < .001), patients with (HR, 1.955; 95% CI, 1.712-2.233; P < .001) and without (HR, 1.578; 95% CI, 1.235-2.2018; P < .001) a history of CAD, and patients with normal (HR, 1.385; 95% CI, 1.194-1.606; P < .001) and abnormal left ventricular ejection fraction (HR, 1.836; 95% CI, 1.299-2.594; P < .001).
Clinical vasodilator stress CMR is associated with patient mortality in a large, diverse population of patients with known or suspected CAD as well as in multiple subpopulations defined by history of CAD and left ventricular ejection fraction. These findings provide a foundational motivation to study the comparative effectiveness of stress CMR against other modalities.
目前在临床实践中并未广泛应用应激心脏磁共振成像（CMR），其预测患者死亡率的能力尚不清楚。
确定应激 CMR 是否与患者死亡率相关。
设计、地点和参与者：连续临床下达的 CMR 检查的真实世界证据。对心肌缺血进行临床评估的多中心研究。在 7 家不同的医院对患有已知或疑似冠状动脉疾病（CAD）的患者进行临床血管扩张剂应激 CMR。一个自动化的过程从最终的临床报告中收集数据，对数据进行去标识和汇总，并使用美国社会安全死亡指数评估死亡率。
全因患者死亡率。
在 9151 例患者中，中位（四分位距）患者年龄为 63（51-70）岁，55%为男性，中位（四分位距）体重指数为 29（25-33）（体重以千克为单位除以身高以米为单位计算）。多中心自动化过程产生了 9151 例连续进行应激 CMR 的患者，随访时间为 48615 患者年。这些患者中，4408 例应激 CMR 检查正常，4743 例检查异常，1517 例在中位随访时间 5.0 年内死亡。使用多变量分析，在 2 个不同的风险模型中添加应激 CMR 可改善死亡率的预测（模型 1 危险比 [HR]，1.83；95%CI，1.63-2.06；P<0.001；模型 2：HR，1.80；95%CI，1.60-2.03；P<0.001），并且还改善了风险再分类（净改善：11.4%；95%CI，7.3-13.6；P<0.001）。在调整患者年龄、性别和心脏危险因素后，Kaplan-Meier 生存分析显示，所有患者中异常应激 CMR 与死亡率之间存在强烈关联（HR，1.883；95%CI，1.680-2.112；P<0.001），包括有（HR，1.955；95%CI，1.712-2.233；P<0.001）和无（HR，1.578；95%CI，1.235-2.2018；P<0.001）CAD 病史的患者，以及左心室射血分数正常（HR，1.385；95%CI，1.194-1.606；P<0.001）和异常（HR，1.836；95%CI，1.299-2.594；P<0.001）的患者。
在患有已知或疑似 CAD 的大量、多样化的患者人群中，以及在根据 CAD 病史和左心室射血分数定义的多个亚组中，临床血管扩张剂应激 CMR 与患者死亡率相关。这些发现为研究应激 CMR 与其他方式的比较效果提供了基础动力。
