Purpose: 

Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear.

Methods: 

We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death.

Results: 

During a mean follow-up of 4.2 ± 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndrome, eight admissions for heart failure, and four all-cause deaths). Once adjusted for clinical, ExECG, and VS-CMR parameters associated with SAE, the only independent predictors were HR_max in ExECG (HR = 0.98: 95% CI, 0.96-0.99; P = .01) and more extensive stress-induced perfusion defects (PDs, number of segments) in VS-CMR (HR = 1.19: 95% CI, 1.07-1.34; P < .01). Adding HR_max significantly improved the predictive power of the multivariable model for SAE, including PDs (continuous reclassification improvement index: 0.47: 95% CI, 0.10-0.81; P < .05). The annualized SAE rate was 1% (if PD < 2 segments and HR_max > 130 bpm), 2% (if PD < 2 segments and HR_max ≤ 130 bpm), 3.2% (if PD ≥ 2 segments and HR_max > 130 bpm), and 6.3% (if PD ≥ 2 segments and HR_max ≤ 130 bpm), P < .01, for the trend. In patients on β-blocker therapy, however, only PDs in VS-CMR, but not HR_max, predicted SAE.

Conclusions: 

We conclude that ExECG contributes significantly to prognostic information beyond VS-CMR in patients with known or suspected CCS.

中文翻译：

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运动心电图测试和负荷心脏磁共振对慢性冠状动脉综合征患者的风险预测

目的： 

血管舒张负荷心脏磁共振 (VS-CMR) 在已知或疑似慢性冠状动脉综合征 (CCS) 患者的检查中变得至关重要。传统运动心电图测试 (ExECG) 是否能提供 VS-CMR 之外的预后信息尚不清楚。

方法： 

我们回顾性纳入了 288 名已知或疑似 CCS 的患者，他们在我们的机构接受了 ExECG 和随后的 VS-CMR。记录临床、ExECG 和 VS-CMR 变量。我们将严重不良事件 (SAE) 定义为急性冠状动脉综合征、心力衰竭入院或全因死亡的综合终点。

结果： 

在平均 4.2 ± 2.15 年的随访期间，我们登记了 27 例 SAE（15 例因急性冠状动脉综合征入院，8 例因心力衰竭入院，4 例全因死亡）。一旦根据与 SAE 相关的临床、ExECG 和 VS-CMR 参数进行调整，唯一的独立预测因素是 ExECG 中的 HR _max（HR = 0.98：95% CI，0.96-0.99；P = 0.01）和更广泛的应激诱导灌注VS-CMR 中的缺陷（PD、节段数）（HR = 1.19：95% CI，1.07-1.34；P < .01）。添加 HR _max显着提高了 SAE 多变量模型的预测能力，包括 PD（持续重新分类改进指数：0.47：95% CI，0.10-0.81；P < .05）。年化 SAE 率为 1%（如果 PD < 2 段且 HR _max > 130 bpm）、2%（如果 PD < 2 段且 HR _max ≤ 130 bpm）、3.2%（如果 PD ≥ 2 段且 HR _max > 130 bpm ） bpm) 和 6.3%（如果 PD ≥ 2 段且 HR _max ≤ 130 bpm），P < .01，用于趋势。然而，在接受 β 受体阻滞剂治疗的患者中，只有 VS-CMR 中的 PD 可预测 SAE，而 HR _{max则不能。}

结论： 

我们的结论是，对于已知或疑似 CCS 的患者，ExECG 对 VS-CMR 之外的预后信息有显着贡献。