在心房颤动患者中，血管扩张剂负荷灌注 CMR 的可行性和预后价值。
Feasibility and Prognostic Value of Vasodilator Stress Perfusion CMR in Patients With Atrial Fibrillation.
机构信息
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France.
出版信息
JACC Cardiovasc Imaging. 2021 Feb;14(2):379-389. doi: 10.1016/j.jcmg.2020.07.041. Epub 2020 Oct 28.
OBJECTIVES
The aim of this study was to assess the feasibility and prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in patients with atrial fibrillation (AF).
BACKGROUND
Because most studies have excluded arrhythmic patients, the prognostic value of stress perfusion CMR in patients with AF is unknown.
METHODS
Between 2008 and 2018, consecutive patients with suspected or stable chronic coronary artery disease and AF referred for vasodilator stress perfusion CMR were included and followed for the occurrence of major adverse cardiovascular event(s) (MACE), defined as cardiovascular death or nonfatal myocardial infarction. The diagnosis of AF was defined by 12-lead electrocardiography before and after CMR. Univariate and multivariate Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.
RESULTS
Of 639 patients (mean age 72 ± 9 years, 77% men), 602 (94%) completed the CMR protocol, and 538 (89%) completed follow-up (median 5.1 years); 80 had MACE. Using Kaplan-Meier analysis, the presence of ischemia (hazard ratio [HR]: 7.56; 95% confidence interval [CI]: 4.86 to 11.80) or LGE (HR: 2.41; 95% CI: 1.55 to 3.74) was associated with the occurrence of MACE (p < 0.001 for both). In a multivariate Cox regression including clinical and CMR indexes, the presence of ischemia (HR: 5.98; 95% CI: 3.68 to 9.73) or LGE (HR: 2.61; 95% CI: 1.89 to 3.60) was an independent predictor of MACE (p < 0.001 for both).
CONCLUSIONS
In patients with AF, stress perfusion CMR is feasible and has good discriminative prognostic value to predict the occurrence of MACE.
目的
本研究旨在评估在心房颤动（AF）患者中使用血管扩张剂负荷灌注心血管磁共振（CMR）的可行性和预后价值。
背景
由于大多数研究排除了心律失常患者，因此尚不清楚应激灌注 CMR 在 AF 患者中的预后价值。
方法
在 2008 年至 2018 年间，连续纳入因疑似或稳定型慢性冠状动脉疾病且伴有 AF 而行血管扩张剂负荷灌注 CMR 检查的患者，并对其进行主要不良心血管事件（MACE）的随访，定义为心血管死亡或非致死性心肌梗死。在 CMR 检查前后通过 12 导联心电图确定 AF 的诊断。通过单变量和多变量 Cox 回归分析来确定 CMR 诱导缺血或晚期钆增强（LGE）的预后价值。
结果
在 639 例患者（平均年龄 72 ± 9 岁，77%为男性）中，602 例（94%）完成了 CMR 检查，538 例（89%）完成了随访（中位随访时间为 5.1 年）；80 例患者发生 MACE。通过 Kaplan-Meier 分析，存在缺血（危险比 [HR]：7.56；95%置信区间 [CI]：4.86 至 11.80）或 LGE（HR：2.41；95%CI：1.55 至 3.74）与 MACE 的发生相关（均为 p<0.001）。在包括临床和 CMR 指标的多变量 Cox 回归中，存在缺血（HR：5.98；95%CI：3.68 至 9.73）或 LGE（HR：2.61；95%CI：1.89 至 3.60）是 MACE 的独立预测因素（均为 p<0.001）。
结论
在 AF 患者中，应激灌注 CMR 是可行的，并且具有良好的预后预测价值，可以预测 MACE 的发生。
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