Marcos-Garces Victor, Merenciano-Gonzalez Hector, Gabaldon-Perez Ana, Nuñez-Marin Gonzalo, Lorenzo-Hernandez Miguel, Gavara Jose, Perez Nerea, Rios-Navarro Cesar, De Dios Elena, Bonanad Clara, Racugno Paolo, Lopez-Lereu Maria Pilar, Monmeneu Jose Vicente, Chorro Francisco Javier, Bodi Vicente
Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain (Drs Marcos-Garces, Merenciano-Gonzalez, Gabaldon-Perez, Nuñez-Marin, Lorenzo-Hernandez, Bonanad, Racugno, Chorro, and Bodi); INCLIVA Health Research Institute, Valencia, Spain (Drs Gavara, Chorro, and Bodi, Mss Perez and De Dios, and Mr Rios-Navarro); Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (Dr Gavara); Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain (Ms De Dios and Drs Chorro and Bodi); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (Drs Lopez-Lereu and Monmeneu); and Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain (Drs Chorro and Bodi).
J Cardiopulm Rehabil Prev. 2022 Jan 1;42(1):E7-E12. doi: 10.1097/HCR.0000000000000621.
Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear.
We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death.
During a mean follow-up of 4.2 ± 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndrome, eight admissions for heart failure, and four all-cause deaths). Once adjusted for clinical, ExECG, and VS-CMR parameters associated with SAE, the only independent predictors were HRmax in ExECG (HR = 0.98: 95% CI, 0.96-0.99; P = .01) and more extensive stress-induced perfusion defects (PDs, number of segments) in VS-CMR (HR = 1.19: 95% CI, 1.07-1.34; P < .01). Adding HRmax significantly improved the predictive power of the multivariable model for SAE, including PDs (continuous reclassification improvement index: 0.47: 95% CI, 0.10-0.81; P < .05). The annualized SAE rate was 1% (if PD < 2 segments and HRmax > 130 bpm), 2% (if PD < 2 segments and HRmax ≤ 130 bpm), 3.2% (if PD ≥ 2 segments and HRmax > 130 bpm), and 6.3% (if PD ≥ 2 segments and HRmax ≤ 130 bpm), P < .01, for the trend. In patients on β-blocker therapy, however, only PDs in VS-CMR, but not HRmax, predicted SAE.
We conclude that ExECG contributes significantly to prognostic information beyond VS-CMR in patients with known or suspected CCS.
血管扩张剂负荷心脏磁共振成像（VS-CMR）在已知或疑似慢性冠状动脉综合征（CCS）患者的检查中已变得至关重要。传统运动心电图测试（ExECG）是否能提供超出VS-CMR的预后信息尚不清楚。
我们回顾性纳入了288例在我院接受过ExECG及随后VS-CMR检查的已知或疑似CCS患者。记录临床、ExECG和VS-CMR变量。我们将严重不良事件（SAE）定义为急性冠状动脉综合征、因心力衰竭住院或全因死亡的综合终点。
在平均4.2±2.15年的随访期间，我们记录到27例SAE（15例因急性冠状动脉综合征住院，8例因心力衰竭住院，4例全因死亡）。在对与SAE相关的临床、ExECG和VS-CMR参数进行调整后，唯一的独立预测因素是ExECG中的最大心率（HRmax）（HR = 0.98：95%CI，0.96 - 0.99；P = 0.01）以及VS-CMR中更广泛的负荷诱导灌注缺损（PDs，节段数）（HR = 1.19：95%CI，1.07 - 1.34；P < 0.01）。加入HRmax显著提高了多变量模型对SAE的预测能力，包括PDs（连续重新分类改善指数：0.47：95%CI，0.10 - 0.81；P < 0.05）。SAE年化发生率在不同情况如下：1%（如果PD < 2个节段且HRmax > 130次/分钟），2%（如果PD < 2个节段且HRmax≤130次/分钟），3.2%（如果PD≥2个节段且HRmax > 130次/分钟），以及6.3%（如果PD≥2个节段且HRmax≤130次/分钟），趋势P < 0.01。然而，在接受β受体阻滞剂治疗的患者中，只有VS-CMR中的PDs而非HRmax能预测SAE。
我们得出结论，在已知或疑似CCS患者中，ExECG能提供超出VS-CMR的显著预后信息。
