Palumbo Pierpaolo, Cannizzaro Ester, Di Cesare Annamaria, Bruno Federico, Arrigoni Francesco, Splendiani Alessandra, Barile Antonio, Masciocchi Carlo, Di Cesare Ernesto
Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, Via Saragat, Località Campo di Pile, 67100 L'Aquila, Italy.
SIRM Foundation, Italian Society of Medical and Interventional Radiology (SIRM), 20122 Milan, Italy.
Diagnostics (Basel). 2022 Mar 23;12(4):786. doi: 10.3390/diagnostics12040786.
(1) Background: The impact of imaging-derived ischemia is still under debate and the role of stress perfusion cardiac magnetic resonance (spCMR) in non-high-risk patient still needs to be clarified. The aim of this study was to evaluate the impact of spCMR in a case series of stable long-standing chronic coronary syndrome (CCS) patients with ischemia and no other risk factor. (2) Methods: This is a historical prospective study including 35 patients with history of long-standing CCS who underwent coronary CT angiography (CCTA) and additional adenosine spCMR. Clinical and imaging findings were included in the analysis. Primary outcomes were HF (heart failure) and all major cardiac events (MACE) including death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, or resuscitated cardiac arrest. (3) Results: Mean follow-up was 3.7 years (IQR: from 1 to 6). Mean ejection fraction was 61 ± 8%. Twelve patients (31%) referred primary outcomes. Probability of experiencing primary outcomes based on symptoms was 62% and increased to 67% and 91% when multivessel disease and ischemia, respectively, were considered. Higher ischemic burden was predictive of disease progression (OR: 1.59, 95%CI: 1.18-2.14; -value = 0.002). spCMR model resulted non inferior to the model comprising all variables (4) Conclusions: In vivo spCMR-modeling including perfusion and strain anomalies could represent a powerful tool in long-standing CCS, even when conventional imaging predictors are missing.
(1) 背景：影像学检查得出的局部缺血的影响仍存在争议，应激灌注心脏磁共振成像（spCMR）在非高危患者中的作用仍有待阐明。本研究的目的是评估spCMR在一系列患有局部缺血且无其他危险因素的稳定型长期慢性冠状动脉综合征（CCS）患者中的影响。(2) 方法：这是一项回顾性前瞻性研究，纳入了35例有长期CCS病史的患者，这些患者接受了冠状动脉CT血管造影（CCTA）及额外的腺苷spCMR检查。分析纳入了临床和影像学检查结果。主要结局为心力衰竭（HF）和所有主要心脏事件（MACE），包括心血管原因导致的死亡、心肌梗死、因不稳定型心绞痛住院或心脏骤停复苏。(3) 结果：平均随访时间为3.7年（四分位间距：1至6年）。平均射血分数为61±8%。12例患者（31%）出现主要结局。基于症状出现主要结局的概率为62%，在考虑多支血管病变和局部缺血时，该概率分别增至67%和91%。更高的局部缺血负荷可预测疾病进展（比值比：1.59，95%置信区间：1.18 - 2.14；P值 = 0.002）。spCMR模型结果不劣于包含所有变量的模型。(4) 结论：即使缺少传统影像学预测指标，包括灌注和应变异常的体内spCMR建模在长期CCS中可能是一种有力工具。
