Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Department of Cardiology, Lariboisiere Hospital-APHP, Inserm UMRS 942, University of Paris, 75010, Paris, France; Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA; Institut Cardiovasculaire Paris Sud (ICPS), Cardiac Computed Tomography Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Institut Cardiovasculaire Paris Sud (ICPS), Cardiac Computed Tomography Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
JACC Cardiovasc Imaging. 2022 Aug;15(8):1408-1422. doi: 10.1016/j.jcmg.2022.03.008. Epub 2022 May 11.
Noninvasive functional imaging is often performed in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CTA). However, the prognostic value of stress cardiac magnetic resonance (CMR) is unknown in patients with coronary stenosis of unknown significance on coronary CTA.
This study assessed the prognostic value of stress CMR in symptomatic patients with obstructive CAD of unknown significance on coronary CTA.
Between 2008 and 2020, consecutive symptomatic patients without known CAD referred for coronary CTA were screened. Patients with obstructive CAD (at least 1 ≥50% stenosis on coronary CTA) were further referred for stress CMR and followed for the occurrence of major adverse cardiovascular events (MACEs), defined as cardiovascular death or nonfatal myocardial infarction.
Of 2,210 patients who completed CMR, 2,038 (46.5% men; mean age 69.8 ± 12.2 years) completed follow-up (median 6.8 years; IQR: 5.9-9.2 years); 281 experienced a MACE (13.8%). Inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with MACEs (HR: 4.51 [95% CI: 3.55-5.74], and HR: 3.32 [95% CI: 2.55-4.32], respectively; P < 0.001). In multivariable Cox regression, the number of segments with >70% stenosis, with noncalcified plaques and the number of vessels with obstructive CAD were prognosticators (P < 0.001). The presence of inducible ischemia and LGE were independent predictors of MACEs (HR: 3.97 [95% CI: 3.43-5.13]; HR: 2.30 [95% CI: 1.52-3.33]; P < 0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional risk factors and coronary CTA (C-statistic improvement: 0.04; net reclassification improvement = 0.421; integrative discrimination index = 0.047).
In symptomatic patients with obstructive CAD of unknown significance on coronary CTA, stress CMR had incremental prognostic value to predict MACEs.
在冠状动脉计算机断层扫描血管造影（CTA）检查中，常对有阻塞性冠状动脉疾病（CAD）的患者进行非侵入性功能成像。然而，在冠状动脉 CTA 显示冠状动脉狭窄意义不明的患者中，应激心脏磁共振（CMR）的预后价值尚不清楚。
本研究评估了在冠状动脉 CTA 显示有阻塞性 CAD 但狭窄意义不明的有症状患者中，应激 CMR 的预后价值。
在 2008 年至 2020 年期间，对连续接受冠状动脉 CTA 检查的无症状 CAD 患者进行了筛查。对有阻塞性 CAD（冠状动脉 CTA 至少有 1 个 ≥50%狭窄）的患者进一步进行应激 CMR 检查，并对主要不良心血管事件（MACE）的发生情况进行随访，MACE 定义为心血管死亡或非致死性心肌梗死。
在完成 CMR 的 2210 例患者中，2038 例（46.5%为男性；平均年龄 69.8±12.2 岁）完成了随访（中位随访时间 6.8 年；IQR：5.9-9.2 年）；281 例发生 MACE（13.8%）。可诱导缺血和晚期钆增强（LGE）与 MACE 显著相关（HR：4.51 [95%CI：3.55-5.74]，HR：3.32 [95%CI：2.55-4.32]；P<0.001）。多变量 Cox 回归分析显示，有>70%狭窄的节段数、无钙化斑块和有阻塞性 CAD 的血管数是预后指标（P<0.001）。可诱导缺血和 LGE 是 MACE 的独立预测因子（HR：3.97 [95%CI：3.43-5.13]；HR：2.30 [95%CI：1.52-3.33]；P<0.001）。校正后，应激 CMR 在预测 MACE 方面优于传统危险因素和冠状动脉 CTA（C 统计量改善：0.04；净重新分类改善=0.421；综合判别指数=0.047）。
在冠状动脉 CTA 显示有阻塞性 CAD 但狭窄意义不明的有症状患者中，应激 CMR 对预测 MACE 具有附加的预后价值。
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