- 作者：Sebastian Kelle ; MD?/sup> ; kelle@dhzb.de ; Amedeo Chiribiri ; MD&dagger ; ; Juliane Vierecke ; MD?/sup> ; Christina Egnell ; MD?/sup> ; Ashraf Hamdan ; MD&Dagger ; ; Cosima Jahnke ; MD?/sup> ; Ingo Paetsch ; MD?/sup> ; Ernst Wellnhofer ; MD?/sup> ; Eckart Fleck ; MD?/sup> ; Christoph Klein ; MD?/sup> ; Rolf Gebker ; MD?/sup>
- 关键词：coronary artery disease ; dobutamine cardiac magnetic resonance ; prognosis
- 刊名：JACC: Cardiovascular Imaging
- 出版年：2011
- 出版时间：February 2011
- 年：2011
- 卷：4
- 期：2
- 页码：161-172
- 全文大小：978 K
Objectives
The aim of this study was to assess the long-term value of high-dose dobutamine cardiac magnetic resonance (DCMR) for the prediction of cardiac events in a large cohort of patients with known or suspected coronary artery disease.Background
High-dose DCMR has been shown to be a useful technique for diagnosis and intermediate-term prognostic stratification.
Methods
Clinical data and DCMR results were analyzed in 1,463 consecutive patients undergoing DCMR between 2000 and 2004. Ninety-four patients were lost to follow-up. The remaining 1,369 patients were followed up for a mean of 44 ¡À 24 months. Cardiac events, defined as cardiac death and nonfatal myocardial infarction, were related to clinical and DCMR results.
Results
Three-hundred fifty-two patients underwent early revascularization (? months of DCMR) and were excluded from analysis. Of the remaining 1,017 patients, 301 patients (29.6 % ) experienced inducible wall motion abnormalities (WMA). Forty-six cardiac events were reported. In those with and without inducible WMA, the proportion of patients with cardiac events was 8.0 % versus 3.1 % , respectively, p = 0.001 (hazard ratio: 3.3; 95 % confidence interval: 1.8 to 5.9 for the presence of inducible WMA; p < 0.001). A DCMR without inducible WMA carried an excellent prognosis, with a 6-year cardiac event-free survival of 96.8 % . In all 1,369 patients in the patient group with stress-inducible WMA, those patients with medical therapy demonstrated a trend to a higher cardiac event rate (8.0 % ) than those with early revascularization (5.4 % ) (p = 0.234). Patients with normal DCMR and medical therapy or early revascularization demonstrated similar cumulative cardiac event rates (3.1 % vs. 3.2 % , p = 0.964).
Conclusions
In a large cohort of patients, DCMR has an added value for predicting cardiac events during long-term follow-up, improving the differentiation between high-risk and low-risk patients. Patients with inducible WMA and following early revascularization, demonstrate lower cardiac event rates than patients with medical therapy alone.