终末期肾病患者应激心血管磁共振成像的可行性及预后价值

Feasibility and Prognostic Value of Stress Cardiovascular Magnetic Resonance in Patients With End-Stage Renal Disease.

作者信息

Rifai Iyad, Ourahma Saida, Broussaud Thomas Ki-Yong, Galichon Pierre, Kachenoura Nadjia, Boussouar Samia, Nguyen Lan-Anh, Charpentier Etienne, Pasi Nicoletta, Chung Cécile, Drouin Sarah, Francois Hélène, Tourret Arnaud Jérôme, Giovachini Louis, Kerneis Mathieu, Montalescot Gilles, Zeitouni Michel, Redheuil Alban

机构信息

Sorbonne Université, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Paris, France; Department of Cardiovascular Imaging, Sorbonne Université, Pitié-Salpêtrière University Hospital AP-HP, Paris, France.

Kidney Transplantation Department, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Unité INSERM UMRS_1155, Des maladies rénales aux maladies fréquentes, remodelage et réparation, Hôpital Tenon, Paris, France.

出版信息

JACC Adv. 2025 Jul 28;4(8):102008. doi: 10.1016/j.jacadv.2025.102008.

DOI:10.1016/j.jacadv.2025.102008

PMID:40730050

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12320657/

Abstract

BACKGROUND

Patients with end-stage renal disease (ESRD) are at high cardiovascular risk. The safety and prognostic value of stress cardiovascular magnetic resonance (CMR) in ESRD patients remains unclear as data are lacking due to perceived contrast agent-related risk.

OBJECTIVES

The authors aimed to assess the safety and prognostic value of stress CMR in asymptomatic ESRD patients on waitlist for kidney transplantation.

METHODS

This was an observational single-center cohort study of asymptomatic patients with ESRD (estimated glomerular filtration rate <30 mL/min/1.73 m or on dialysis) referred for stress CMR. Patterns of abnormal perfusion and late gadolinium enhancement were classified as typical or atypical for ischemic heart disease. Patients were followed for the occurrence of major adverse cardiovascular events (MACE) and contrast-related complications.

RESULTS

Of 3328 ESRD patients, 845 (age 60 years [53-66], 67% men) were included with a median follow-up of 5.4 years. No major CMR-related adverse events occurred. Abnormal perfusion (12%) and presence of late gadolinium enhancement (22%) were strongly associated with the occurrence of MACE and remained independent of traditional risk factors including prior coronary disease (respectively, aHR: 4.76 [95% CI: 3.34-6.79]; aHR: 3.86 [95% CI: 2.59-5.74]; P < 0.001). Both typical and atypical ischemic heart disease patterns were independently associated with MACE (aHR: 5.68 [95% CI: 3.39-9.52] and aHR: 5.84 [95% CI: 3.82-8.91]; P < 0.001). CMR findings improved prognostic accuracy beyond American Heart Association 2012 risk criteria for ESRD patients (C-statistic improvement: 0.10).

CONCLUSIONS

In ESRD patients, stress CMR is feasible, safe, and adds significant prognostic value for MACE beyond traditional risk factors by characterizing patterns of microvascular and macrovascular disease.

摘要

背景

终末期肾病（ESRD）患者心血管风险较高。由于担心造影剂相关风险，缺乏相关数据，因此应激心血管磁共振成像（CMR）在ESRD患者中的安全性和预后价值尚不清楚。

目的

作者旨在评估应激CMR在等待肾移植的无症状ESRD患者中的安全性和预后价值。

方法

这是一项针对因应激CMR前来就诊的无症状ESRD患者（估计肾小球滤过率<30 mL/min/1.73 m²或正在接受透析）的单中心观察性队列研究。将异常灌注和钆剂延迟强化模式分为缺血性心脏病的典型或非典型模式。对患者进行主要不良心血管事件（MACE）和造影剂相关并发症发生情况的随访。

结果

在3328例ESRD患者中，纳入了845例（年龄60岁[53 - 66岁]，67%为男性），中位随访时间为5.4年。未发生与CMR相关的重大不良事件。异常灌注（12%）和钆剂延迟强化的存在（22%）与MACE的发生密切相关，并且独立于包括既往冠心病在内的传统风险因素（分别为：调整后风险比[aHR]：4.76[95%置信区间：3.34 - 6.79]；aHR：3.86[95%置信区间：2.59 - 5.74]；P<0.001）。典型和非典型缺血性心脏病模式均与MACE独立相关（aHR：5.68[95%置信区间：3.39 - 9.52]和aHR：5.84[95%置信区间：3.82 - 8.91]；P<0.001）。CMR检查结果提高了ESRD患者超出美国心脏协会2012年风险标准的预后准确性（C统计量改善：0.10）。