应激灌注心脏磁共振成像在心血管疾病中的预后价值:扫描仪、应激剂和分析技术影响的系统回顾和元分析》。

IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiology. Cardiothoracic imaging Pub Date : 2024-06-01 DOI:10.1148/ryct.230382
Qing Fu, Samer Alabed, Stephen P Hoole, George Abraham, Jonathan R Weir-McCall
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Comparisons were performed across different analysis techniques (qualitative, semiquantitative, and fully quantitative), magnetic field strengths (1.5 T vs 3 T), and stress agents (dobutamine, adenosine, and dipyridamole). Results Thirty-eight studies with 58 774 patients with a mean follow-up time of 53 months were included. There were 1.9 all-cause deaths and 3.5 major adverse cardiovascular events (MACE) per 100 patient-years. Stress-inducible ischemia was associated with a higher risk of all-cause mortality (HR: 2.55 [95% CI: 1.89, 3.43]) and MACE (HR: 3.90 [95% CI: 2.69, 5.66]). For MACE, pooled HRs of qualitative, semiquantitative, and fully quantitative methods were 4.56 (95% CI: 2.88, 7.22), 3.22 (95% CI: 1.60, 6.48), and 1.78 (95% CI: 1.39, 2.28), respectively. For all-cause mortality, there was no evidence of a difference between qualitative and fully quantitative methods (<i>P</i> = .79). Abnormal stress perfusion cardiac MRI findings remained prognostic when subgrouped based on underlying disease, stress agent, and field strength, with HRs of 3.54, 2.20, and 3.38, respectively, for all-cause mortality and 3.98, 3.56, and 4.21, respectively, for MACE. There was no evidence of subgroup differences in prognosis between field strengths or stress agents. There was significant heterogeneity in effect size for MACE outcomes in the subgroups assessing qualitative versus quantitative stress perfusion analysis, underlying disease, and field strength. 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引用次数: 0

摘要

目的 对应激灌注心脏磁共振成像在预测心血管疾病预后方面的价值进行系统回顾和荟萃分析。材料和方法 系统性检索了从 PubMed、Embase、Web of Science 和中国国家知识基础设施开始到 2023 年 1 月的文献,以寻找报道应激灌注心脏磁共振成像在预测心血管预后方面的文章。纳入研究的质量采用预后研究质量工具进行评估。将单变量回归分析报告的危险比 (HR) 与 95% CIs 汇总。对不同的分析技术(定性、半定量和完全定量)、磁场强度(1.5 T 与 3 T)和应激药物(多巴酚丁胺、腺苷和双嘧达莫)进行比较。结果 共纳入 38 项研究,58 774 名患者,平均随访时间为 53 个月。每 100 名患者年中有 1.9 例全因死亡和 3.5 例主要不良心血管事件 (MACE)。应激诱导性心肌缺血与较高的全因死亡风险(HR:2.55 [95% CI:1.89, 3.43])和主要不良心血管事件风险(MACE:HR:3.90 [95% CI:2.69, 5.66])相关。对于 MACE,定性、半定量和完全定量方法的汇总 HR 分别为 4.56(95% CI:2.88,7.22)、3.22(95% CI:1.60,6.48)和 1.78(95% CI:1.39,2.28)。在全因死亡率方面,没有证据表明定性方法和完全定量方法之间存在差异(P = .79)。根据基础疾病、应激剂和磁场强度进行亚组时,异常应激灌注心脏 MRI 结果仍具有预后意义,全因死亡率的 HR 分别为 3.54、2.20 和 3.38,MACE 的 HR 分别为 3.98、3.56 和 4.21。没有证据表明不同场强或应激剂在预后方面存在亚组差异。在评估定性与定量应激灌注分析、潜在疾病和场强的亚组中,MACE结局的效应大小存在明显的异质性。结论 无论使用哪种分析方法、应激剂或磁场强度,应激灌注心脏 MRI 对预测心血管预后都有价值。关键词MR-灌注 MRI 心脏病 Meta 分析 压力灌注 心脏 MR 心血管疾病 预后 定量 © RSNA, 2024 这篇文章有补充材料。
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Prognostic Value of Stress Perfusion Cardiac MRI in Cardiovascular Disease: A Systematic Review and Meta-Analysis of the Effects of the Scanner, Stress Agent, and Analysis Technique.

Purpose To perform a systematic review and meta-analysis to assess the prognostic value of stress perfusion cardiac MRI in predicting cardiovascular outcomes. Materials and Methods A systematic literature search from the inception of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure until January 2023 was performed for articles that reported the prognosis of stress perfusion cardiac MRI in predicting cardiovascular outcomes. The quality of included studies was assessed using the Quality in Prognosis Studies tool. Reported hazard ratios (HRs) of univariable regression analyses with 95% CIs were pooled. Comparisons were performed across different analysis techniques (qualitative, semiquantitative, and fully quantitative), magnetic field strengths (1.5 T vs 3 T), and stress agents (dobutamine, adenosine, and dipyridamole). Results Thirty-eight studies with 58 774 patients with a mean follow-up time of 53 months were included. There were 1.9 all-cause deaths and 3.5 major adverse cardiovascular events (MACE) per 100 patient-years. Stress-inducible ischemia was associated with a higher risk of all-cause mortality (HR: 2.55 [95% CI: 1.89, 3.43]) and MACE (HR: 3.90 [95% CI: 2.69, 5.66]). For MACE, pooled HRs of qualitative, semiquantitative, and fully quantitative methods were 4.56 (95% CI: 2.88, 7.22), 3.22 (95% CI: 1.60, 6.48), and 1.78 (95% CI: 1.39, 2.28), respectively. For all-cause mortality, there was no evidence of a difference between qualitative and fully quantitative methods (P = .79). Abnormal stress perfusion cardiac MRI findings remained prognostic when subgrouped based on underlying disease, stress agent, and field strength, with HRs of 3.54, 2.20, and 3.38, respectively, for all-cause mortality and 3.98, 3.56, and 4.21, respectively, for MACE. There was no evidence of subgroup differences in prognosis between field strengths or stress agents. There was significant heterogeneity in effect size for MACE outcomes in the subgroups assessing qualitative versus quantitative stress perfusion analysis, underlying disease, and field strength. Conclusion Stress perfusion cardiac MRI is valuable for predicting cardiovascular outcomes, regardless of the analysis method, stress agent, or magnetic field strength used. Keywords: MR-Perfusion, MRI, Cardiac, Meta-Analysis, Stress Perfusion, Cardiac MR, Cardiovascular Disease, Prognosis, Quantitative © RSNA, 2024 Supplemental material is available for this article.

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