Background

Cardiovascular magnetic resonance imaging (CMR) is an accurate technique for assessing ventricular function, myocardial perfusion and viability; its development remains limited mainly because of logistical and time constraints. Data regarding optimization of a dedicated stress CMR workflow are needed.

Aims

This study aimed to describe the optimization of a dedicated workflow, and to assess the feasibility and safety of stress CMR in a large registry of > 35,000 patients.

Methods

A large single-centre French registry of vasodilator stress CMR included consecutive patients referred between 2008 and 2019 for the detection of inducible ischaemia. Stress CMR was performed at 1.5 Tesla using dipyridamole. Clinical and demographic data, test quality, CMR findings, haemodynamic data and complications were recorded prospectively. A locally optimized workflow was described and evaluated.

Results

Among the 35,862 patients referred for vasodilator stress CMR (mean age 68.9 ± 11.8 years; 64.1% male), the stress CMR protocol was completed in 35,013 (97.6%) patients; 144 (0.3%) patients with missing baseline data were excluded. The mean examination duration was 27 ± 5 min, with image quality optimal in 90.8%, suboptimal in 7.1% and poor in 0.5% of cases. Images were diagnostic in 97.9% of patients. No patients died during or immediately after CMR. Fifty-six (0.16%) patients had severe complications. The incidence of non-severe complications was low (1.5%), whereas minor symptoms occurred frequently (35.5%). The presence of ischaemia was associated with a higher incidence of severe complications, non-severe complications and minor symptoms (all P < 0.001).

Conclusions

This single-centre prospective registry of > 35,000 referral patients with known or suspected CAD showed that stress CMR was feasible in clinical routine practice, with high diagnostic image quality and an excellent safety profile. Inducible ischaemia was associated with severe complications, non-severe complications and minor symptoms.

中文翻译：

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血管舒张应激心血管磁共振成像：超过 35,000 名患者的大型前瞻性登记的可行性、工作流程和安全性

背景

心血管磁共振成像 (CMR) 是一种评估心室功能、心肌灌注和存活率的准确技术；由于后勤和时间限制，其发展仍然有限。需要有关优化专用应力 CMR 工作流程的数据。

宗旨

本研究旨在描述专用工作流程的优化，并在 超过 35,000 名患者的大型注册中评估压力 CMR 的可行性和安全性。

方法

法国一项大型单中心血管扩张剂应激 CMR 登记处包括在 2008 年至 2019 年间转诊以检测诱导性缺血的连续患者。使用双嘧达莫在 1.5 特斯拉进行应力 CMR。前瞻性地记录临床和人口统计学数据、测试质量、CMR 结果、血流动力学数据和并发症。描述和评估了本地优化的工作流程。

结果

在转诊接受血管扩张剂应激 CMR 的 35,862 名患者（平均年龄 68.9  ±  11.8 岁；64.1% 男性）中，35,013 (97.6%) 名患者完成了应激 CMR 协议；排除基线数据缺失的 144 名 (0.3%) 患者。平均检查持续时间为 27  ±  5 分钟，图像质量最佳为 90.8%，次优为 7.1%，差为 0.5%。图像对 97.9% 的患者具有诊断意义。没有患者在 CMR 期间或之后立即死亡。56 名 (0.16%) 患者出现严重并发症。非严重并发症的发生率较低 (1.5%)，而轻微症状则频繁发生 (35.5%)。缺血的存在与严重并发症、非严重并发症和轻微症状的发生率较高有关（所有P  < 0.001）。

结论

这项针对 >  35,000 名已知或疑似 CAD 转诊患者的单中心前瞻性登记表明，压力 CMR 在临床常规实践中是可行的，具有高诊断图像质量和出色的安全性。诱导性缺血与严重并发症、非严重并发症和轻微症状有关。