Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
PLoS One. 2024 Oct 10;19(10):e0311875. doi: 10.1371/journal.pone.0311875. eCollection 2024.
Stress perfusion cardiac magnetic resonance (CMR) is an accurate and comprehensive modality for evaluating patients with suspected coronary artery disease (CAD), but its prognostic value in prediabetic patients is uncertain.
This retrospective study included 452 consecutive prediabetic patients without prior diagnoses of CAD who underwent adenosine stress perfusion CMR. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular death, nonfatal myocardial infarction (MI), hospitalization for heart failure, ischemic stroke, and late coronary revascularization (>90 days post-CMR). The secondary endpoint was a composite of cardiovascular death, nonfatal MI, and hospitalization for heart failure.
The mean age was 68±11 years (49% male). Over a median follow-up time of 8.1 (IQR 5.7, 10.4) years, 55 patients experienced MACE, and 24 met the secondary endpoint. Patients with inducible ischemia had significantly greater annualized event rates for MACE (5.7% vs. 0.7%, p<0.001) and for the secondary endpoint (2.0% vs. 0.3%, p<0.001) than those without ischemia. Multivariable analysis revealed inducible ischemia as a consistent predictor for MACE (HR 3.36, 95%CI 1.90-5.94, p<0.001) and for the secondary endpoint (HR 2.89, 95%CI 1.22-6.80, p = 0.01). Late gadolinium enhancement (LGE) was an independent predictor of the secondary endpoint (HR 3.56, 95%CI 1.25-10.13; p = 0.02). Incorporating inducible ischemia and LGE data significantly improved the model's ability to discriminate MACE risk (C-statistic increase from 0.77 to 0.83; net reclassification improvement 0.42; integrated discrimination improvement 0.05).
Stress perfusion CMR offers substantial independent prognostic value and effectively aids in reclassifying cardiovascular risk among prediabetic patients with suspected CAD.
负荷心脏磁共振（CMR）是一种评估疑似冠心病（CAD）患者的准确且全面的方法，但在糖尿病前期患者中的预后价值尚不确定。
本回顾性研究纳入了 452 例连续的糖尿病前期患者，这些患者均无 CAD 的既往诊断，并接受了腺苷负荷灌注 CMR 检查。主要终点是主要不良心血管事件（MACE），定义为心血管死亡、非致死性心肌梗死（MI）、心力衰竭住院、缺血性卒中和冠状动脉血运重建后 90 天以上（CMR 后）。次要终点是心血管死亡、非致死性 MI 和心力衰竭住院的复合终点。
患者平均年龄为 68±11 岁（49%为男性）。中位随访时间为 8.1（IQR 5.7，10.4）年，55 例患者发生 MACE，24 例患者达到次要终点。有可诱导缺血的患者 MACE（5.7%比 0.7%，p<0.001）和次要终点（2.0%比 0.3%，p<0.001）的年化事件发生率显著更高。多变量分析显示，可诱导缺血是 MACE（HR 3.36，95%CI 1.90-5.94，p<0.001）和次要终点（HR 2.89，95%CI 1.22-6.80，p=0.01）的一致预测因素。晚期钆增强（LGE）是次要终点的独立预测因素（HR 3.56，95%CI 1.25-10.13；p=0.02）。纳入可诱导缺血和 LGE 数据可显著提高模型区分 MACE 风险的能力（C 统计量从 0.77 增加到 0.83；净重新分类改善 0.42；综合判别改善 0.05）。
负荷灌注 CMR 提供了显著的独立预后价值，并有效地帮助对疑似 CAD 的糖尿病前期患者进行心血管风险再分类。
