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冠状动脉疾病患者的非缺血性或双重心肌病
Parag Bawaskar1, Nicholas Thomas1, Khaled Ismail1
1Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (P.B., N.T., K.I., Y.G., S.C., P.S.S.A., A.R., A.J., A.H.M., I.N., D.F., P.V., T.E., H.A., A.K., C.S.).
Circulation
|November 6, 2023
概括
在冠状动脉疾病 (CAD) 患者中,非缺血性心肌病 (NICM) 是常见的,并且与更糟糕的结果有关. 这一发现可能解释了为什么在某些阻塞性CAD患者中,再血管化没有预后益处.
科学领域:
- 心脏病学
- 心血管成像
- 心脏衰竭的研究
背景情况:
- 随机试验显示,在阻塞性冠状动脉疾病 (CAD) 中,再血管化的预后益处有限.
- 偶然的非缺血性心肌病 (NICM) 是这种缺乏益处的一个不充分研究的原因.
- 本研究调查了NICM在CAD患者中的患病率和预后意义.
研究的目的:
- 在患有阻塞性冠状动脉疾病 (CAD) 的患者中确定非缺血性心肌病 (NICM) 的患病率.
- 评估同时存在的NICM对CAD患者的长期结果的预后影响.
- 探索NICM在解释阻塞性CAD冠状动脉再血管化的缺乏益处方面的潜在作用.
主要方法:
- 在2004年至2020年期间,对3023名患有阻塞性CAD的患者进行了对比增强心血管磁共振成像 (CMR) 的注册研究.
- 使用CMR和冠状动脉血管学数据确定心肌病类型 (缺血性,非缺血性或双重).
- 主要结局:综合死亡或心力衰竭住院. 二次结果:全因死亡,心力衰竭住院,心血管死亡.
主要成果:
- 在3023名患者中,有16. 9%的患者同时患有非缺血性心肌病 (NICM) 或双重心肌病 (CAD+NICM或CAD+双重心肌病).
- 与仅患有缺血性心肌病 (CAD+ICM) 的患者相比,CAD+NICM或CAD+双CM患者的主要结局 (全因死亡或心力衰竭住院) 的风险显著更高 (aHR,1.23;P=0.007).
- 在CAD+NICM或CAD+双CM组中观察到所有原因死亡和心力衰竭住院的风险较高,但心血管死亡风险没有差异.
结论:
- 在接受CMR治疗的CAD患者中,大约有1名患有非缺血性心肌病 (NICM) 或双重心肌病.
- 与单独的缺血性心肌病相比,NICM在阻塞性CAD患者中的存在独立地与更糟糕的长期结果有关.
- 在某些阻塞性CAD患者中,偶然的NICM可能有助于观察到冠状动脉再血管化的预后效益不足.
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