缺血性心脏病试验中不同负荷试验方式下缺血严重程度与冠状动脉疾病的关系
Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial.
作者信息
Reynolds Harmony R, Page Courtney B, Shaw Leslee J, Berman Daniel S, Chaitman Bernard R, Picard Michael H, Kwong Raymond Y, Min James K, Leipsic Jonathon, Mancini G B John, Budoff Matthew J, Hague Cameron J, Senior Roxy, Szwed Hanna, Bhargava Balram, Celutkiene Jelena, Gadkari Milind, Bainey Kevin R, Doerr Rolf, Ramos Ruben B, Ong Peter, Naik Sudhir R, Steg Philippe Gabriel, Goetschalckx Kaatje, Chow Benjamin J W, Scherrer-Crosbie Marielle, Phillips Lawrence, Mark Daniel B, Spertus John A, Alexander Karen P, O'Brien Sean M, Boden William E, Bangalore Sripal, Stone Gregg W, Maron David J, Hochman Judith S
机构信息
Cardiovascular Clinical Research Center, Department of Medicine, NYU Grossman School of Medicine, New York, NY (H.R.R., L.P., S.B., J.S.H.).
Duke Clinical Research Institute, Durham, NC (C.B.P., D.B.M., K.P.A., S.M.O.).
出版信息
Circ Cardiovasc Interv. 2024 Dec;17(12):e013743. doi: 10.1161/CIRCINTERVENTIONS.123.013743. Epub 2024 Dec 17.
BACKGROUND
The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.
METHODS
Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test. Among those with preserved renal function who underwent coronary computed tomography angiography, we examined relationships between ischemia and CAD by coronary computed tomography angiography, overall, and by stress test modality, regardless of subsequent randomization. Core laboratories categorized ischemia as severe, moderate, mild, or none, while the extent and severity of anatomic CAD were categorized based on the modified Duke prognostic index.
RESULTS
Among 3601 participants with interpretable stress tests and coronary computed tomography angiography, ischemia severity was weakly associated with CAD extent/severity (r=0.27), with modest variability in strength of association by modality: nuclear (n=1532; r=0.40), echocardiography (n=827; r=0.15), cardiac magnetic resonance imaging (n=108; r=0.31), and exercise tolerance test (n=1134; r=0.18). The extent of infarction on nuclear imaging and echocardiography was weakly associated with CAD extent/severity.
CONCLUSIONS
Overall, ischemia severity on stress testing showed weak to moderate associations with the anatomic extent of CAD in this cohort with moderate or severe ischemia on local interpretation and controlled symptoms.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
背景
在患有阻塞性冠状动脉疾病（CAD）的患者中，应激诱导的缺血程度和严重程度与解剖学冠状动脉疾病（CAD）的程度和严重程度之间的关系是多因素的，包括所达到的应激强度、所使用的检测类型、既往梗死的存在和范围、侧支血流、斑块特征、微血管疾病、冠状动脉血管舒缩张力以及遗传因素。在患有部位确定的中度或重度缺血的慢性冠状动脉疾病参与者中，我们研究了应激试验中缺血严重程度与冠状动脉计算机断层扫描血管造影（CTA）上CAD范围之间的关联。
方法
临床指示的应激试验包括核成像、超声心动图、心脏磁共振成像或非成像运动耐量试验。在接受冠状动脉CTA且肾功能正常的患者中，我们通过冠状动脉CTA总体上以及按应激试验方式检查了缺血与CAD之间的关系，无论随后是否随机分组。核心实验室将缺血分类为重度、中度、轻度或无缺血，而解剖学CAD的范围和严重程度则根据改良的杜克预后指数进行分类。
结果
在3601名具有可解释的应激试验和冠状动脉CTA的参与者中，缺血严重程度与CAD范围/严重程度呈弱相关（r = 0.27），各方式的关联强度存在适度差异：核成像（n = 1532；r = 0.40）、超声心动图（n = 827；r = 0.15）、心脏磁共振成像（n = 108；r = 0.31）和运动耐量试验（n = 1134；r = 0.18）。核成像和超声心动图上的梗死范围与CAD范围/严重程度呈弱相关。
结论
总体而言，在这个局部解释为中度或重度缺血且症状得到控制的队列中，应激试验中的缺血严重程度与CAD的解剖学范围呈弱至中度相关。
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