Marcos-Garces Victor, Gavara Jose, Monmeneu Jose V, Lopez-Lereu Maria P, Perez Nerea, Rios-Navarro Cesar, De Dios Elena, Moratal David, Miñana Gema, Nuñez Julio, Chorro Francisco J, Bodi Vicente
Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain.
Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain.
J Clin Med. 2020 Jun 23;9(6):1957. doi: 10.3390/jcm9061957.
Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age ≥ 65 years = 3 points, LVEF ≤ 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score ≥ 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts ( > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS.
血管扩张剂负荷心脏磁共振成像（负荷CMR）已在已知或疑似慢性冠状动脉综合征（CCS）患者中显示出强大的诊断和预后价值。然而，负荷CMR与临床变量整合到一个简单的临床成像评分中能否直接预测该人群的全因死亡率尚不清楚。我们纳入了一个大型登记研究中的6187例因已知或疑似CCS接受负荷CMR检查的患者。收集了多个临床和负荷CMR变量，如左心室射血分数（LVEF）和缺血负荷（负荷诱发灌注缺损（PD）的节段数）。在中位随访5.56年期间，我们记录了682例（11%）全因死亡病例。多变量分析中全因死亡率的唯一独立预测因素是年龄、男性、糖尿病（DM）、LVEF和缺血负荷。基于多变量分析每一步卡方增加量的权重，我们创建了一个简单的临床-负荷CMR（C-CMR-10）评分，该评分包括这些变量（年龄≥65岁=3分，LVEF≤50%=3分，DM=2分，男性=1分，缺血负荷>5个节段=1分）。这个0至10分的C-CMR-10评分在预测全因年化死亡率方面表现良好，范围从0.29%/年（评分=0）到>4.6%/年（评分≥7）。该模型和C-CMR-10评分的良好性能在2个内部队列（每个队列>3000例）中分别得到了证实。我们得出结论，一种新的、简单的临床-负荷CMR评分（包括临床和负荷CMR变量）能够为已知或疑似CCS患者群体的长期全因死亡风险提供可靠预测。
