慢性冠状动脉综合征患者选择性经皮冠状动脉介入治疗前后全冠状动脉血流储备的预后价值。

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-09-25 DOI:10.1016/j.jocmr.2024.101106
Kai Nogami, Masahiro Hoshino, Eisuke Usui, Yoshihisa Kanaji, Tomoyo Sugiyama, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Mirei Setoguchi, Tomohiro Tahara, Tatsuya Sakamoto, Takashi Mineo, Tsunekazu Kakuta
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引用次数: 0

摘要

背景:通过相位对比电影心血管磁共振(PC-CMR)评估的冠状动脉血流储备(G-CFR)受损与心血管疾病患者的不良预后有关。本研究旨在探讨经皮冠状动脉介入治疗(PCI)前后使用 PC-CMR 成像评估的 G-CFR 改善的预后价值:在这项单中心研究中,对接受PCI前后PC-CMR测量的320名慢性冠状动脉综合征(CCS)患者进行了随访,以确定主要不良心脏或脑血管事件(MACCE)的预测因素。MACCE 被定义为心源性死亡、非致死性心肌梗死、因心力衰竭住院或缺血性中风的综合征。研究调查了包括基线数据在内的 CMR 参数、PCI 后 G-CFR 变化与 MACCE 之间的关联:结果:在中位 2.5 年的随访期间,165 例(51.6%)患者的 G-CFR 有所改善,26 例(8.1%)患者出现 MACCE。G-CFR的改善与PCI前较低的G-CFR明显相关。对数秩检验显示,PCI 后 G-CFR 无改善的患者与预后不良之间存在显著关联。PCI前G-CFR较低且G-CFR无改善的患者MACCE发生率最高。多变量考克斯比例危险模型显示,G-CFR改善不足是独立于PCI前G-CFR和SYNTAX评分的重要MACCE预测因素:结论:除了PCI前和PCI后较低的G-CFR与较差的预后之间存在关联外,PCI后G-CFR是否改善也可为CCS患者选择PCI后的预后提供新的见解。
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Prognostic Value of Global Coronary Flow Reserve Before and After Elective Percutaneous Coronary Intervention in Patients with Chronic Coronary Syndrome.

Background: Impaired global coronary flow reserve (G-CFR), evaluated through phase-contrast cine cardiovascular magnetic resonance (PC-CMR), has been linked to worse outcomes in patients with cardiovascular disease. This study aimed to investigate the prognostic value of G-CFR improvement, as evaluated using PC-CMR imaging pre- and post-percutaneous coronary intervention (PCI).

Methods: In this single-center study, 320 patients with chronic coronary syndrome (CCS) who underwent pre- and post-PCI PC-CMR measurements were followed-up to determine major adverse cardiac or cerebrovascular events (MACCE) predictors. MACCE was defined as a composite of cardiac death, nonfatal myocardial infarction, hospitalization due to heart failure, or ischemic stroke. The association between CMR parameters, including baseline data, G-CFR changes post-PCI and MACCE was investigated.

Results: G-CFR improvement was observed in 165 (51.6%) patients, while MACCE occurred in 26 (8.1%) during a median follow-up period of 2.5 years. G-CFR improvement was significantly associated with a lower pre-PCI G-CFR. The log-rank test revealed a significant association between patients without G-CFR improvement post-PCI and a poor prognosis. Patients with lower pre-PCI G-CFR and lack of G-CFR improvement exhibited the highest incidence of MACCE. The multivariable Cox proportional hazard model revealed that lack of G-CFR improvement was an independently significant MACCE predictor from pre-PCI G-CFR and SYNTAX score.

Conclusions: Besides the association between pre- and post-PCI lower G-CFR and worse prognosis, the presence or absence of G-CFR improvement post-PCI may provide novel insights into the prognosis following elective PCI in patients with CCS.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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