对患有胸痛且没有阻塞性冠状动脉疾病的患者进行内型化治疗:一项随机试验
Conor P Bradley1,2, Gemma McKinley3, Vanessa Orchard2
1British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Nature medicine
|November 10, 2025
概括
压力心血管磁共振成像 (MRI) 引导管理改善了无阻塞冠状动脉患者的胸痛诊断和生活质量. 这种方法重新分类了超过一半的参与者的诊断,显著提高了他们的健康结果.
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
- 临床试验 临床试验
背景情况:
- 许多患有胸痛的患者缺乏阻塞性冠状动脉疾病,导致诊断不确定.
- 在这些情况下,经常不使用功能诊断测试.
- 压力心血管磁共振成像 (MRI) 可以评估心肌血流量并检测冠状动脉微血管功能障碍,但缺乏随机试验证据.
研究的目的:
- 评估腺应激心血管MRI导向管理的临床效用.
- 确定这种方法是否能改善胸痛和胸痛和冠状动脉不堵塞的患者的心痛和与健康有关的生活质量.
主要方法:
- 一个前性的,多中心的,随机对照的优越性试验,涉及250名患者.
- 患者被随机分配1:1到应激心血管MRI导向管理或标准护理.
- 主要结局是12个月的西雅图心痛问卷 (SAQ) 总结得分.
主要成果:
- 诊断研究的主要结果 (诊断的重新分类) 在53.0%的患者中得到满足.
- 干预组在12个月后显示出明显更高的SAQ总结得分 (70.9比52.1).
- 在EQ-5D-5L生活质量调查问卷中也注意到了改善.
结论:
- 使用压力心血管核磁共振 (MRI) 进行的内型化告知疗法,在超过一半的患有胸痛和冠状动脉不阻塞的患者中修订了诊断.
- 这一策略显著改善了心肌痛症状和与健康有关的生活质量.
- 氨酸应激心血管MRI指导的管理对于这个患者群体来说是临床有效的.
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