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Association Between Impaired Myocardial Flow Reserve on 82Rubidium Positron Emission Tomography Imaging and Adverse Events in Patients With Autoimmune Rheumatic Disease
Circulation: Cardiovascular Imaging ( IF 6.5 ) Pub Date : 2021-09-10 , DOI: 10.1161/circimaging.120.012208
Attila Feher 1 , Nabil E Boutagy 2, 3 , Evangelos K Oikonomou 1 , Yi-Hwa Liu 1 , Edward J Miller 1 , Albert J Sinusas 1, 4, 5 , Monique Hinchcliff 6, 7
Affiliation  

Background:Coronary microvascular dysfunction has been described in patients with autoimmune rheumatic disease (ARD). However, it is unknown whether positron emission tomography (PET)-derived myocardial flow reserve (MFR) can predict adverse events in this population.Methods:Patients with ARD without coronary artery disease who underwent dynamic rest-stress 82Rubidium PET were retrospectively studied and compared with patients without ARD matched for age, sex, and comorbidities. The association between MFR and a composite end point of mortality or myocardial infarction or heart failure admission was evaluated with time to event and Cox-regression analyses.Results:In 101 patients with ARD (88% female, age: 62±10 years), when compared with matched patients without ARD (n=101), global MFR was significantly reduced (median: 1.68 [interquartile range: 1.34–2.05] versus 1.86 [interquartile range: 1.58–2.28]) and reduced MFR (<1.5) was more frequent (40% versus 22%). MFR did not differ among subtypes of ARDs. In survival analysis, patients with ARD and low MFR (MFR<1.5) had decreased event-free survival for the combined end point, when compared with patients with and without ARD and normal MFR (MFR>1.5) and when compared with patients without ARD and low MFR, after adjustment for the nonlaboratory-based Framingham risk score, rest left ventricular ejection fraction, severe coronary calcification, and the presence of medium/large perfusion defects. In Cox-regression analysis, ARD diagnosis and reduced MFR were both independent predictors of adverse events along with congestive heart failure diagnosis and presence of medium/large stress perfusion defects on PET. Further analysis with inclusion of an interaction term between ARD and impaired MFR revealed no significant interaction effects between ARD and impaired MFR.Conclusions:In our retrospective cohort analysis, patients with ARD had significantly reduced PET MFR compared with age-, sex-, and comorbidity-matched patients without ARD. Reduced PET MFR and ARD diagnosis were both independent predictors of adverse outcomes.

中文翻译:

自身免疫性风湿病患者 82 铷正电子发射断层显像心肌血流储备受损与不良事件之间的关联

背景:已经在自身免疫性风湿病 (ARD) 患者中描述了冠状动脉微血管功能障碍。然而,尚不清楚正电子发射断层扫描 (PET) 衍生的心肌血流储备 (MFR) 是否可以预测该人群的不良事件。方法:接受动态静息应激的 ARD 患者无冠状动脉疾病82对铷 PET 进行了回顾性研究,并与年龄、性别和合并症相匹配的非 ARD 患者进行了比较。通过事件发生时间和 Cox 回归分析评估 MFR 与死亡率或心肌梗死或心力衰竭入院的复合终点之间的关联。结果:在 101 名 ARD 患者中(88% 为女性,年龄:62±10 岁),与无 ARD 的匹配患者(n=101)相比,总体 MFR 显着降低(中位数:1.68 [四分位距:1.34-2.05] 对比 1.86 [四分位距:1.58-2.28])并且 MFR 降低(<1.5)更多频繁(40% 对 22%)。MFR 在 ARD 亚型之间没有差异。在生存分析中,与伴有和不伴有 ARD 且 MFR 正常(MFR>1. 5) 与没有 ARD 和低 MFR 的患者相比,在调整了基于非实验室的 Framingham 风险评分、静息左心室射血分数、严重的冠状动脉钙化和中/大灌注缺损的存在后。在 Cox 回归分析中,ARD 诊断和 MFR 降低都是不良事件以及充血性心力衰竭诊断和 PET 上存在中/大应力灌注缺陷的独立预测因素。进一步分析包括 ARD 和 MFR 受损之间的交互项,显示 ARD 和 MFR 受损之间没有显着的交互作用。结论:在我们的回顾性队列分析中,与年龄、性别和合并症相比,ARD 患者的 PET MFR 显着降低-匹配的无急性呼吸道疾病患者。
更新日期:2021-09-22
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