通过压力心电图和压力成像进行比较预后:来自ISCHEMIA试验的结果
Leslee J Shaw1, Lawrence M Phillips2, Jonathon Leipsic3
1Icahn School of Medicine at Mount Sinai, New York, New York, USA.
压力成像和运动心电图有效预测慢性冠状动脉综合征 (CCS) 的结果. 痕负担和减少的射出分数是关键风险指标,而CMR的缺血程度显示出预后价值.
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
- 预防医学 预防医学
背景情况:
- 目前关于使用压力成像和运动心电图 (ECG) 预测慢性冠状动脉综合征 (CCS) 患者的风险的证据有限.
- 该ISCHEMIA研究为研究这些诊断工具在大型CCS队列中的预后能力提供了一个独特的机会.
研究的目的:
- 评估核心实验室定义的压力成像和炼慢性冠状动脉综合征 (CCS) 患者心电图发现的预后价值.
- 评估成像和心电图参数以及临床试验关键终点之间的关联.
主要方法:
- 总共有5,179名来自ISCHEMIA研究的患者被分析,利用压力核成像,心声学,心磁共振 (CMR) 和心电图的数据.
- 考克斯模型被用来评估试验终点与诸如痕/缺血段,休息/压力左心室喷射率 (LVEF) 和ST段抑郁等措施之间的关联.
- 对初级复合终点,心血管死亡,自发性心脏病发作,手术性心脏病发作和2型心脏病发作进行了预后模型的检查.
主要成果:
- 痕段数量和休息/压力LVEF是主要复合终点 (心血管死亡,心脏病发作,心脏骤停或住院) 的显著预测指标.
- 痕和休息/压力LVEF在心声回声和核成像上的范围预测了多个试验终点.
- 缺血细分预测了自发性和程序性心脏病发作,而CMR预测的缺血程度预测了初级终点和自发性心脏病发作.
结论:
- 压力成像和运动心电图测量表明,在CCS患者中,与关键临床终点存在可变但显著的关联.
- 压力CMR缺血显示出预后价值,支持其在评估CCS患者中的扩大作用.
- 来自ISCHEMIA试验的结果描述了缺血和心脏病发作的风险模式,有助于对CCS风险分层.
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