心力衰竭伴射血分数降低患者的血管扩张剂应激心血管磁共振的安全性和预后价值。

Safety and Prognostic Value of Vasodilator Stress Cardiovascular Magnetic Resonance in Patients With Heart Failure and Reduced Ejection Fraction.

机构信息

Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France (T.P., F.S., M.K., V.L., P.G., T.H., T.U., S.C., Y.L., M.C.M., J.G.).

Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, France (G.B.).

出版信息

Circ Cardiovasc Imaging. 2020 Sep;13(9):e010599. doi: 10.1161/CIRCIMAGING.120.010599. Epub 2020 Sep 2.

DOI:10.1161/CIRCIMAGING.120.010599

PMID:32873071

Abstract

BACKGROUND

Patients with heart failure with reduced ejection fraction (HFrEF; heart failure with reduced left ventricular ejection fraction <40%) referred for stress cardiovascular magnetic resonance (CMR) may have a less optimal hemodynamic response to intravenous vasodilator. The aim was to assess the prognostic value of vasodilator stress perfusion CMR in patients with HFrEF.

METHODS

Between 2008 and 2018, consecutive patients with HFrEF defined by left ventricular ejection fraction <40% prospectively referred for vasodilator stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement by CMR.

RESULTS

Of 1053 patients with HFrEF (65±11 years, median [interquartile range] left ventricular ejection fraction 38.7% [37.2-39.0]), 1018 (97%) completed the CMR protocol and 950 (93%) completed the follow-up (median [interquartile range], 5.6 [3.6-7.3] years); 117 experienced a MACE (12.3%). Stress CMR was well tolerated without any adverse events. Patients without ischemia or late gadolinium enhancement experienced a lower annual event rate of MACE (1.8%) than those with both ischemia and late gadolinium enhancement (12.0%; <0.001). Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement were significantly associated with the occurrence of MACE (hazard ratio, 2.46 [95% CI, 1.69-3.60]; and hazard ratio, 2.92 [95% CI, 1.77-4.83], respectively, both <0.001). In multivariable Cox regression, inducible ischemia was an independent predictor of a higher incidence of MACE (hazard ratio, 2.26 [95% CI, 1.52-3.35]; <0.001).

CONCLUSIONS

Stress CMR is safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients with HFrEF.

摘要

背景

射血分数降低的心力衰竭（HFrEF；左心室射血分数<40%的心力衰竭）患者进行静脉内血管扩张剂应激心血管磁共振（CMR）检查可能对静脉内血管扩张剂的血液动力学反应较差。目的是评估 HFrEF 患者血管扩张剂应激灌注 CMR 的预后价值。

方法

2008 年至 2018 年，连续前瞻性地将射血分数<40%的 HFrEF 患者（左心室射血分数<40%）转介至血管扩张剂应激灌注 CMR 检查，这些患者的主要不良心血管事件（MACE）的发生率（定义为心血管死亡或非致死性心肌梗死）。使用单变量和多变量 Cox 回归分析来确定 CMR 诱导缺血或晚期钆增强的预后价值。

结果

1053 例 HFrEF 患者（65±11 岁，中位数[四分位数间距]左心室射血分数 38.7%[37.2-39.0]）中，1018 例（97%）完成了 CMR 方案，950 例（93%）完成了随访（中位数[四分位数间距]，5.6[3.6-7.3]年）；117 例发生 MACE（12.3%）。应激 CMR 耐受性良好，无任何不良事件。无缺血或晚期钆增强的患者发生 MACE 的年事件率（1.8%）低于同时存在缺血和晚期钆增强的患者（12.0%；<0.001）。Kaplan-Meier 分析显示，诱导性缺血和晚期钆增强与 MACE 的发生显著相关（风险比，2.46[95%可信区间，1.69-3.60]；风险比，2.92[95%可信区间，1.77-4.83]，均<0.001）。在多变量 Cox 回归中，诱导性缺血是 MACE 发生率较高的独立预测因素（风险比，2.26[95%可信区间，1.52-3.35]；<0.001）。