Abstract:
Background: This study investigated the prognostic value of cardiovascular magnetic resonance (CMR)-derived global coronary flow reserve (G-CFR) in addition to cardiopulmonary exercise testing (CPET) variables in patients with acute myocardial infarction (AMI). Methods and Results: We investigated 127 patients with AMI who underwent primary or urgent percutaneous coronary intervention (PCI) and post-intervention CMR and CPET. The incidence of major cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent non-fatal myocardial infarction, re-hospitalization due to congestive heart failure, and stroke, was evaluated (median follow-up, 2.8 years). Patients with MACCE (n=14) had lower ejection fraction (EF) (50 [43-59] vs. 58 [51-63]%; P=0.014), lower G-CFR (1.74 [1.19-2.20] vs. 2.40 [1.61-3.66]; P=0.008), and lower peak oxygen consumption (V̇O2) (15.16±2.64 vs. 17.19±3.70 mL/kg/min; P=0.049) than patients without MACCE. G-CFR<2.33 and peak V̇O2 <15.65 mL/kg/min (cut-off values derived from receiver operating characteristic curve analyses) were significantly associated with the incidence of MACCE (log-rank test, P=0.01). The combination of low G-CFR and low peak V̇O2 improved risk discrimination for MACCE when added to the reference clinical model including age, male sex, post-PCI peak creatine kinase, EF, and left anterior descending artery culprit lesion. Conclusions: G-CFR and peak V̇O2 showed incremental prognostic information compared with the reference model using historically important clinical risk factors, indicating that this approach may help identify high-risk patients who suffer subsequent adverse events.
摘要:
背景:这项研究调查了心血管磁共振(CMR)衍生的全球冠状动脉血流储备(G-CFR)以及心肺运动试验(CPET)变量在急性心肌梗死(AMI)患者中的预后价值。方法和结果:我们调查了127例接受初次或紧急经皮冠状动脉介入治疗(PCI)以及介入后CMR和CPET的AMI患者。主要心脑血管事件(MACCE)的发生率,定义为全因死亡,复发性非致死性心肌梗死,由于充血性心力衰竭再次住院,和中风,进行了评估(中位随访,2.8年)。MACCE患者(n=14)的射血分数(EF)较低(50[43-59]vs.58[51-63]%;P=0.014),较低的G-CFR(1.74[1.19-2.20]与2.40[1.61-3.66];P=0.008),和较低的峰值耗氧量(V²O2)(15.16±2.64vs.17.19±3.70mL/kg/min;P=0.049)比没有MACCE的患者。G-CFR<2.33和峰值V²O2<15.65mL/kg/min(从受试者工作特征曲线分析得出的临界值)与MACCE的发生率显着相关(对数秩检验,P=0.01)。低G-CFR和低峰值V-O2的组合在增加到参考临床模型(包括年龄)时改善了MACCE的风险辨别。男性,PCI术后肌酸激酶峰值,EF,和左前降支罪犯病变。结论:与使用历史重要临床危险因素的参考模型相比,G-CFR和峰值V炭黑显示出增量的预后信息。表明这种方法可能有助于识别随后发生不良事件的高危患者.