Adenosine triphosphate (ATP) has been predominantly used in the Asia–Pacific region for stress perfusion cardiovascular magnetic resonance (CMR). We evaluated the prognosis of patients stressed using ATP, for which there are no current data. We performed a retrospective longitudinal study from January 2016 to December 2020 and included 208 subjects with suspected obstructive coronary artery disease (CAD) who underwent ATP stress perfusion CMR. An inducible stress perfusion defect was defined as a subendocardial dark rim involving ≥ 1.5 segments that persisted for ≥ 6 beats during stress but not at rest. The primary outcome measure was a composite of major adverse cardiovascular events (MACE) including (1) cardiac death, (2) nonfatal myocardial infarction, (3) cardiac hospitalization, (4) late coronary revascularization. We compared outcomes in patients with and without perfusion defect using Kaplan–Meier and log rank tests. Significant predictors of MACE were identified using multivariable Cox regression analysis. Median follow-up was 3.3 years. Patients with no stress perfusion defect had a lower incidence of MACE (p < 0.001), including lower cardiac hospitalization (p = 0.004), late coronary revascularization (p = 0.001) and cardiac death (p = 0.003). Significant independent predictors for MACE were stress induced perfusion defect (p < 0.001, hazard ratio [HR] = 3.63), lower left ventricular ejection fractino (LVEF) (p < 0.001, HR = 0.96) and infarct detected by late gadolinium enhancement (LGE) (p = 0.001, HR = 2.92). Perfusion defects on ATP stress are predictive of MACE which is driven primarily by cardiac hospitalization, late coronary revascularization and cardiac death. Significant independent predictors of MACE were stress induced perfusion defect, lower LVEF and infarct detected by LGE.

中文翻译：

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灌注心血管磁共振与三磷酸腺苷应激对稳定型冠状动脉疾病的预后价值


三磷酸腺苷 (ATP) 在亚太地区主要用于应激灌注心血管磁共振 (CMR)。我们使用 ATP 评估了有压力的患者的预后，目前尚无相关数据。我们从 2016 年 1 月至 2020 年 12 月进行了一项回顾性纵向研究，纳入了 208 名疑似阻塞性冠状动脉疾病 (CAD) 的受试者，他们接受了 ATP 应激灌注 CMR。诱导性应激灌注缺陷定义为涉及≥ 1.5 个节段的心内膜下深色边缘，在应激期间持续≥ 6 次心跳，但在休息时则不然。主要结局指标是主要不良心血管事件（MACE）的综合，包括（1）心源性死亡，（2）非致命性心肌梗死，（3）心脏住院，（4）晚期冠状动脉血运重建。我们使用 Kaplan-Meier 和对数秩检验比较了有和没有灌注缺陷患者的结果。使用多变量 Cox 回归分析确定了 MACE 的重要预测因子。中位随访时间为 3.3 年。无应激灌注缺陷的患者的 MACE 发生率较低 (p < 0.001)，包括较低的心脏住院率 (p = 0.004)、晚期冠状动脉血运重建 (p = 0.001) 和心源性死亡 (p = 0.003)。 MACE 的显着独立预测因子是应激诱发的灌注缺陷（p < 0.001，风险比 [HR] = 3.63）、左心室射血分数（LVEF）下限（p < 0.001，HR = 0.96）和晚期钆增强检测到的梗塞（LGE）（p = 0.001，HR = 2.92）。 ATP 应激的灌注缺陷可预测 MACE，其主要由心脏住院、晚期冠状动脉血运重建和心源性死亡引起。 MACE 的显着独立预测因素是应激引起的灌注缺陷、较低的 LVEF 和 LGE 检测到的梗塞。