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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.
