Gaibazzi Nicola, Rigo Fausto, Lorenzoni Valentina, Pasqualetto Cristina, Foà Alberto, Cagliari Enrico, Cavasin Nicola, Botti Andrea, Martini Chiara, Tuttolomondo Domenico
Department of Cardiology, Parma University Hospital, 43126 Parma, Italy.
Division of Cardiology, Villa Salus Hospital Foundation/IRCCS San Camillo, 30126 Venice, Italy.
J Clin Med. 2023 Jan 23;12(3):903. doi: 10.3390/jcm12030903.
This study aimed to assess which variables on coronary computed tomography angiography (CTA) and vasodilator stress-echocardiography (SE) are best associated with long-term cardiac outcome in patients presenting for suspected chronic coronary syndrome (CCS) who performed both tests.
We identified 397 patients with suspected CCS who, between 2007 and 2019, underwent both SE and CTA within 30 days. Coronary artery calcium score (CACS) and the number of coronary arteries with diameter stenosis >50% were assessed on CTA. The presence of reversible regional wall motion abnormalities (RWMA) and reduced Doppler coronary flow velocity reserve in the left-anterior descending coronary artery (CFVR) were assessed on SE. The association of SE and CTA variables with cardiac outcome (cardiac death or myocardial infarction) was evaluated using Fine and Gray competing risk models.
During a median follow-up of 10 years, 38 (9.6%) patients experienced a nonfatal myocardial infarction and 19 (4.8%) died from a cardiac cause. RWMA (HR 7.189, < 0.001) and a lower CFVR (HR 0.034, < 0.001) on SE, along with CACS (HR 1.004, < 0.001) and the number of >50% stenosed coronary vessels (HR 1.975, < 0.001) on CTA, were each associated with cardiac events. After adjusting for covariates, only CACS and CFVR remained associated (both < 0.001) with cardiac outcome.
Our data suggest that only CFVR on vasodilatory SE and CACS on CTA are independently and strongly associated with long-term cardiac outcome, unlike RWMA or the number of stenosed coronary arteries, usually considered the hallmarks of coronary artery disease on each test.
本研究旨在评估对于疑似慢性冠状动脉综合征（CCS）且同时接受了冠状动脉计算机断层扫描血管造影（CTA）和血管扩张剂负荷超声心动图（SE）检查的患者，CTA和SE上的哪些变量与长期心脏预后最相关。
我们纳入了397例疑似CCS患者，这些患者在2007年至2019年期间于30天内先后接受了SE和CTA检查。在CTA上评估冠状动脉钙化积分（CACS）以及直径狭窄>50%的冠状动脉数量。在SE上评估可逆性节段性室壁运动异常（RWMA）的存在情况以及左前降支冠状动脉的多普勒冠状动脉血流速度储备降低情况（CFVR）。使用Fine和Gray竞争风险模型评估SE和CTA变量与心脏预后（心源性死亡或心肌梗死）之间的关联。
在中位随访10年期间，38例（9.6%）患者发生非致命性心肌梗死，19例（4.8%）死于心脏原因。SE上的RWMA（风险比7.189，P<0.001）和较低的CFVR（风险比0.034，P<0.001），以及CTA上的CACS（风险比1.004，P<0.001）和狭窄>50%的冠状动脉血管数量（风险比1.975，P<0.001），均与心脏事件相关。在对协变量进行校正后，只有CACS和CFVR仍与心脏预后相关（均P<0.001）。
我们的数据表明，与RWMA或狭窄冠状动脉数量不同，血管扩张剂负荷SE上的CFVR和CTA上的CACS与长期心脏预后独立且密切相关，而RWMA或狭窄冠状动脉数量通常被认为是每项检查中冠状动脉疾病的标志。
