Stephenson Cardiac Imaging Center, University of Calgary, Calgary, Alberta, Canada.
Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
JACC Cardiovasc Imaging. 2023 Jun;16(6):749-764. doi: 10.1016/j.jcmg.2022.11.025. Epub 2023 Feb 8.
Cardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations.
In this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD.
Sex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) Registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting.
SPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality.
Stress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891).
心血管疾病（CVD）仍然是女性死亡的主要原因，但目前的非侵入性心脏成像技术存在性别特异性局限性。
本研究旨在探讨压力灌注心脏磁共振（CMR）对疑似 CVD 患者的预后价值以及下游侵入性血运重建和成本的性别差异。
在一项包含 2349 名患者的多中心 SPINS（美国压力 CMR 灌注成像研究[SPINS]研究）注册研究中，评估了性别对预后的影响。主要观察指标是心血管死亡和非致死性心肌梗死的复合终点；次要终点是不稳定型心绞痛或心力衰竭住院治疗，以及晚期非计划性冠状动脉旁路移植术。
SPINS 纳入 1104 名女性（队列的 47%）；女性胸痛发生率较高（62% vs 50%；P<0.0001），但药物治疗使用率较低。中位随访 5.4 年后，正常压力 CMR 的女性主要复合终点的年化发生率与男性相似（分别为 0.54%/年和 0.75%/年，P=NS）。相比之下，CMR 异常的女性发生主要（3.74%/年 vs 0.54%/年；P<0.0001）和次要（9.8%/年 vs 1.6%/年；P<0.0001）结局的风险更高。异常压力 CMR 是主要（HR：2.64[95%CI：1.20-5.90]；P=0.02）和次要（HR：2.09[95%CI：1.43-3.08]；P<0.0001）结局的独立预测因素。性别对预后没有影响。女性在 CMR 检查后 90 天内进行侵入性冠状动脉造影的比例（3.6% vs 7.3%；P=0.0001）和下游费用（$114 vs $171；P=0.001）均较低。性别对诊断图像质量无影响。
压力 CMR 显示出良好的预后性能，在女性中的侵入性冠状动脉造影转诊率较低。压力 CMR 应作为女性评估的一线非侵入性成像工具。（美国压力 CMR 灌注成像研究[SPINS]研究[NCT03192891]）。
