Phase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to measure coronary sinus blood flow (CSBF) and coronary flow reserve (CFR). We aimed to compare the prognostic value of resting CSBF and CFR for predicting major adverse cardiac events (MACE) in patients with known or suspected coronary artery disease (CAD) who underwent vasodilator stress CMR. We studied 693 patients with known CAD and 519 patients with suspected CAD admitted to our hospital between 2009 and 2019. The CFR was calculated as the CSBF during adenosine triphosphate infusion divided by CSBF at rest. MACE was defined as composite of cardiovascular death, acute coronary syndrome, heart failure hospitalization, and sustained ventricular tachyarrhythmia. During a median follow-up of 4.6 years, 92 patients (8%) experienced MACE. The resting CSBF was significantly higher in patients with MACE than in patients without MACE (114.7 ± 44.9 mL/min vs. 84.7 ± 30.9 mL/min, p < 0.001 for known CAD; 122.2 ± 33.3 mL/min vs. 86.6 ± 36.7 mL/min, p < 0.001 for suspected CAD). The resting CSBF remained a significant predictor for MACE after adjusting clinical and CMR variables (hazard ratio [HR] of resting CSBF higher than the median: 3.18, p = 0.0083 for known CAD; HR: 23.3, p < 0.001 for suspected CAD). The area under the curve for predicting MACE was 0.73 for resting CSBF, 0.72 for CFR (p = 0.78) in patients with known CAD, and 0.82 for resting CSBF, 0.83 (p = 0.58) for CFR in patients with suspected CAD. The resting CSBF may be a useful non-invasive method for the risk stratification of patients with known or suspected CAD without any radiation exposure, contrast media, or pharmacological vasodilator agents.

中文翻译：

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相衬电影心血管磁共振测定已知或疑似冠状动脉疾病患者静息冠状窦血流的预后价值


冠状窦相衬电影心血管磁共振 (CMR) 已成为测量冠状窦血流量 (CSBF) 和冠状动脉血流储备 (CFR) 的无创方法。我们的目的是比较静息 CSBF 和 CFR 对预测接受血管扩张剂应激 CMR 的已知或疑似冠状动脉疾病 (CAD) 患者的主要不良心脏事件 (MACE) 的预后价值。我们研究了 2009 年至 2019 年间入住我院的 693 名已知 CAD 患者和 519 名疑似 CAD 患者。CFR 的计算方法为三磷酸腺苷输注期间的 CSBF 除以静息时的 CSBF。 MACE 被定义为心血管死亡、急性冠状动脉综合征、心力衰竭住院和持续性室性快速心律失常的复合疾病。在中位随访 4.6 年期间，92 名患者 (8%) 经历了 MACE。患有 MACE 的患者的静息 CSBF 显着高于无 MACE 的患者（114.7 ± 44.9 mL/min 对比 84.7 ± 30.9 mL/min，对于已知 CAD，p < 0.001；122.2 ± 33.3 mL/min 对比 86.6 ± 36.7 mL） /min，对于可疑 CAD，p < 0.001）。调整临床和 CMR 变量后，静息 CSBF 仍然是 MACE 的重要预测因素（静息 CSBF 的风险比 [HR] 高于中位数：3.18，对于已知 CAD，p = 0.0083；HR：23.3，对于疑似 CAD，p < 0.001）。已知 CAD 患者的静息 CSBF 预测 MACE 曲线下面积为 0.73，CFR 预测曲线下面积为 0.72 (p = 0.78)，疑似 CAD 患者的静息 CSBF 预测曲线下面积为 0.82，CFR 预测曲线下面积为 0.83 (p = 0.58)。静息 CSBF 可能是一种有用的非侵入性方法，可用于对已知或疑似 CAD 患者进行风险分层，无需任何辐射暴露、造影剂或药理学血管扩张剂。