Long-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance

JACC-CARDIOVASCULAR IMAGING

卷:14

Article

Zhou, Wenli¹  Lee, Jonan Chun Yin²  Leung, Siu Ting³  Lai, Alta³  Lee, Tang-Fei³  Chiang, Jeanie Betsy²  Cheng, Yuet Wong⁴  Chan, Hiu-Lam⁵  Yiu, Kai-Hang⁶  Goh, Victor King-Man^7,8  Pennell, Dudley John^9,10  Ng, Ming-Yen^1,11 

[1] Univ Hong Kong, Dept Diagnost Radiol, Hong Kong, Peoples R China

[2] Queen Elizabeth Hosp, Dept Radiol & Imaging, Hong Kong, Peoples R China

[3] Pamela Youde Nethersole Eastern Hosp, Dept Radiol, Hong Kong, Peoples R China

[4] Queen Elizabeth Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China

[5] Pamela Youde Nethersole Eastern Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China

[6] Univ Hong Kong, Dept Med, Div Cardiol, Hong Kong, Peoples R China

[7] Hong Kong Sanat & Hosp, Hong Kong, Peoples R China

[8] Chinese Univ Hong Kong, Sch Publ Hlth, Hong Kong, Peoples R China

[9] Royal Brompton & Harefield NHS Fdn Trust, Cardiovasc Magnet Resonance Unit, London, England

[10] Imperial Coll, Natl Heart & Lung Inst, London, England

[11] Univ Hong Kong, Shenzhen Hosp, Dept Med Imaging, Shenzhen, Peoples R China

关键词: coronary microvascular disease;    MPRI;    prognosis;    stress CMR;   

DOI  :  10.1016/j.jcmg.2020.09.034

来源: Elsevier

【 摘 要 】

OBJECTIVES This study investigated the prognosis of coronary microvascular disease (CMD) as determined by stress perfusion cardiac magnetic resonance (CMR) in patients with ischemic symptoms but without significant coronary artery disease (CAD). BACKGROUND Patients with CMD have poorer prognosis with various cardiac diseases. The myocardial perfusion reserve index (MPRI) derived from noninvasive stress perfusion CMR has been established to diagnose microvascular angina with a threshold MPRI <1.4. The prognosis of CMD as determined by MPRI is unknown. METHODS Chest pain patients without epicardial CAD or myocardial disease from January 2009 to December 2017 were retrospectively included from 3 imaging centers in Hong Kong (H K). Stress perfusion CMR examinations were performed using either adenosine or adenosine triphosphate. Adequate stress was assessed by achieving splenic switch-off sign. Measurement of MPRI was performed in all stress perfusion CMR scans. Patients were followed for major adverse cardiovascular events defined as all-cause death, acute coronary syndrome (ACS), epicardial CAD development, heart failure hospitalization and non-fatal stroke. RESULTS A total of 218 patients were studied (mean age 59 +/- 12 years; 49.5% male) and the average MPRI of that cohort was 1.56 +/- 0.33. Females and a history of hyperlipidemia were predictors of lower MPRI. Major adverse cardiovascular events (MACE) occurred in 15.6% of patients during a median follow-up of 5.5 years (interquartite range: 4.6 to 6.8 years). The optimal cutoff value of MPRI in predicting MACE was found with a threshold MPRI <= 1.47. Patients with MPRI <= 1.47 had three-fold increased risk of MACE compared with those with MPRI >1.47 (hazard ratio [HR]: 3.14; 95% confidence interval [CI]: 1.58 to 6.25; p = 0.001). Multivariate Cox regression after adjusting for age and hypertension demonstrated that MPRI was an independent predictor of MACE (HR: 0.10; 95% CI: 0.03 to 0.34; p < 0.001). CONCLUSIONS Stress perfusion CMR-derived MPRI is an independent imaging marker that predicts MACE in patients with ischemic symptom and no overt CAD over the medium term. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

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