Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Division of Cardiology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand.
BMC Cardiovasc Disord. 2023 Oct 10;23(1):502. doi: 10.1186/s12872-023-03532-0.
Cardiovascular magnetic resonance (CMR) comprehensively assesses aortic stiffness and myocardial ischemia in a single examination. Aortic stiffness represents a subclinical marker of cardiovascular risk in the general population, including patients with diabetes mellitus. However, there is no prognostic data regarding aortic stiffness in patients with diabetes mellitus undergoing stress perfusion CMR.
Consecutive patients with diabetes mellitus with suspected myocardial ischemia referred for adenosine stress perfusion CMR with aortic pulse wave velocity (PWV) during 2010-2013 were studied. The primary outcome was major adverse cardiovascular events (MACE), defined as the composite of cardiac mortality, nonfatal myocardial infarction (MI), hospitalization for heart failure, coronary revascularization (> 90 days post-CMR), and ischemic stroke. The secondary outcome was hard cardiac events, defined as the composite of cardiac mortality and nonfatal MI.
A total of 424 patients (median follow-up 7.2 years) were included. The mean PWV was 12.16 ± 6.28 m/s. MACE and hard cardiac events occurred in 26.8% and 9.4% of patients, respectively. Patients with elevated PWV (> 12.16 m/s) had a significantly higher incidence of MACE (HR 2.14 [95%CI 1.48, 3.09], p < 0.001) and hard cardiac events (HR 2.69 [95%CI 1.42, 5.10], p = 0.002) compared to those with non-elevated PWV. Multivariable analysis demonstrated that PWV independently predicts MACE (p = 0.003) and hard cardiac events (p = 0.01). Addition of PWV provided incremental prognostic value beyond clinical data, left ventricular mass index, myocardial ischemia, and late gadolinium enhancement in predicting MACE (incremental χ² 7.54, p = 0.006) and hard cardiac events (incremental χ² 5.99, p = 0.01).
Aortic stiffness measured by CMR independently predicts MACE and hard cardiac events and confers significant incremental prognostic value in patients with diabetes mellitus with suspected myocardial ischemia. Aortic stiffness measurement could potentially be considered as part of a stress perfusion CMR protocol to enhance risk prediction in patients with diabetes mellitus.
心血管磁共振（CMR）可在单次检查中全面评估主动脉僵硬度和心肌缺血。主动脉僵硬度是一般人群心血管风险的亚临床标志物，包括糖尿病患者。然而，对于接受腺苷负荷灌注 CMR 的糖尿病患者，尚无关于主动脉僵硬度的预后数据。
对 2010 年至 2013 年期间因疑似心肌缺血而行腺苷负荷灌注 CMR 检查且同时测量主动脉脉搏波速度（PWV）的连续糖尿病患者进行研究。主要终点是主要不良心血管事件（MACE），定义为心脏性死亡、非致死性心肌梗死（MI）、因心力衰竭住院、冠状动脉血运重建（CMR 后>90 天）和缺血性卒中的复合终点。次要终点是硬性心脏事件，定义为心脏性死亡和非致死性 MI 的复合终点。
共纳入 424 例患者（中位随访 7.2 年）。平均 PWV 为 12.16±6.28 m/s。26.8%和 9.4%的患者发生 MACE 和硬性心脏事件。PWV 升高（>12.16 m/s）的患者发生 MACE 的发生率明显更高（HR 2.14 [95%CI 1.48, 3.09]，p<0.001）和硬性心脏事件（HR 2.69 [95%CI 1.42, 5.10]，p=0.002）高于 PWV 不升高的患者。多变量分析表明，PWV 可独立预测 MACE（p=0.003）和硬性心脏事件（p=0.01）。与临床数据、左心室质量指数、心肌缺血和钆延迟增强相比，PWV 可提供额外的预测价值，可分别提高预测 MACE（附加 χ² 7.54，p=0.006）和硬性心脏事件（附加 χ² 5.99，p=0.01）的能力。
CMR 测量的主动脉僵硬度可独立预测 MACE 和硬性心脏事件，并为疑似心肌缺血的糖尿病患者提供显著的附加预后价值。主动脉僵硬度的测量可能会被考虑作为腺苷负荷灌注 CMR 方案的一部分，以增强糖尿病患者的风险预测。
