应激心血管磁共振成像对隐源性缺血性卒中后心血管风险分层的额外预后价值。
Additional prognostic value of stress cardiovascular magnetic resonance for cardiovascular risk stratification after a cryptogenic ischemic stroke.
作者信息
Toupin Solenn, Pezel Théo, Sanguineti Francesca, Kinnel Marine, Hovasse Thomas, Unterseeh Thierry, Champagne Stéphane, Garot Philippe, Garot Jérôme
机构信息
Siemens Healthcare France, Saint-Denis, France.
Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
出版信息
Front Cardiovasc Med. 2022 Sep 14;9:956950. doi: 10.3389/fcvm.2022.956950. eCollection 2022.
BACKGROUND
One-third of ischemic strokes are "cryptogenic" without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest in CAD screening in patients with cryptogenic stroke is still debated.
AIM
The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.
MATERIALS AND METHODS
Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACEs), defined by cardiovascular death or non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.
RESULTS
Of 542 patients (55.2% male, mean age 71.4 ± 8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18 and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE [hazard ratio, HR: 8.43 (95% CI: 5.11-13.9); HR: 7.87 (95% CI: 4.80-12.9), respectively, < 0.001]. In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE [HR: 8.08 (95% CI: 4.21-15.5); HR: 6.65 (95% CI: 3.49-12.7), respectively, < 0.001]. After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI = 0.428; IDI = 0.048).
CONCLUSION
In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.
背景
三分之一的缺血性中风是“隐源性的”，病因不明。尽管冠状动脉疾病（CAD）是中风后主要的死亡原因，但对于隐源性中风患者进行CAD筛查的意义仍存在争议。
目的
本研究旨在评估应激心血管磁共振成像（CMR）相对于传统危险因素在预测既往有隐源性缺血性中风患者心血管事件方面的增量预后价值。
材料与方法
2008年至2021年期间，纳入连续的既往有隐源性中风且接受应激CMR检查的患者，并随访主要不良心血管事件（MACE）的发生情况，MACE定义为心血管死亡或非致命性心肌梗死（MI）。进行单变量和多变量Cox回归分析以确定未识别的MI和无症状性缺血的预后价值。
结果
在完成随访（中位时间5.9年）的542例患者（男性占55.2%，平均年龄71.4±8.8岁）中，66例（12.2%）发生了MACE。分别有18%和17%的患者检测到无症状性缺血和未识别的MI。采用Kaplan-Meier分析，无症状性缺血和未识别的MI均与MACE的发生相关[风险比，HR：8.43（95%CI：5.11-13.9）；HR：7.87（95%CI：4.80-12.9），P均<0.001]。在多变量分析中，无症状性缺血和未识别的MI是MACE的独立预测因素[HR：8.08（95%CI：4.21-15.5）；HR：6.65（95%CI：3.49-12.7），P均<0.001]。调整后，应激CMR检查结果在模型辨别和重新分类方面显示出相对于传统危险因素的最佳改善（C统计量改善：0.13；NRI=0.428；IDI=0.048）。
结论
对于既往有隐源性中风的患者，应激CMR检查结果在预测MACE方面相对于传统危险因素具有增量预后价值。
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