scholarly journals Stress perfusion CMR provides strong long-term prognostic value to cardiac events irrespective of patient sex

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
F Sanguineti ◽  
M Kinnel ◽  
V Landon ◽  
P Garot ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND    Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men due to a lack of early diagnosis and management. Numerous clinical studies have shown that stress cardiovascular magnetic resonance (CMR) detects evidence of myocardial ischemia and infarction at high accuracy. However, long-term prognosis data are limited.  PURPOSE The aim of this study was to test the hypothesis that stress perfusion CMR imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men.  METHODS   Consecutive patients referred for vasodilator stress perfusion CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. The safety of the CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR in each sex.  RESULTS Of 3436 patients referred for stress CMR in a single French center, 3322 (97%) completed the CMR protocol (59.9 ± 11.8 years, 57% men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4 ± 0.2 years). Reasons for failure to complete CMR included renal failure (n = 29), claustrophobia (n = 26), poor gating (n = 22), intolerance to stress agent (n = 19) and declining participation (n = 18).  Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of inducible myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36 ; 95% confidence interval CI: 1.54–3.62; p < 0.001) and men (HR 3.57 ; 95% confidence interval CI: 2.75 – 4.64; p < 0.001) (Figure). Moreover, inducible ischemia was associated with cardiovascular death for both women (hazard ratio HR 1.92; 95% confidence interval CI: 1.12 – 2.74; p = 0.04) and men (HR 2.71 ; 95% confidence interval CI: 1.98 – 4.41; p < 0.001).  In a multivariable stepwise Cox regression including clinical characteristics and CMR, presence of inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85 ; 95% confidence interval CI: 1.18 – 2.92; p = 0.008) and men (HR 3.55 ; 95% confidence interval CI: 2.73 – 4.63; p < 0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65 – 3.01; p < 0.01) but not for women (p = 0.11).  CONCLUSION Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients of either sex presenting with inducible ischemia. However, inducible ischemia is an independent predictor of a higher incidence of CV mortality only in men. Abstract Figure.

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
F Sanguineti ◽  
M Kinnel ◽  
V Landon ◽  
P Garot ◽  
...  

Abstract Background Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men due to a lack of early diagnosis and management. Numerous clinical studies have shown that stress cardiovascular magnetic resonance (CMR) detects evidence of myocardial ischemia and infarction at high accuracy. However, long-term prognosis data are limited. Purpose The aim of this study was to test the hypothesis that stress perfusion CMR imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. Material Consecutive patients referred for vasodilator stress perfusion CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. The safety of the CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR in each sex. Results Of 3436 patients referred for stress CMR in a single French center, 3322 (97%) completed the CMR protocol (59.9±11.8 years, 57% men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4±0.2 years). Reasons for failure to complete CMR included renal failure (n=29), claustrophobia (n=26), poor gating (n=22), intolerance to stress agent (n=19) and declining participation (n=18). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of inducible myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36; 95% confidence interval CI: 1.54–3.62; p<0.001) and men (HR 3.57; 95% confidence interval CI: 2.75–4.64; p<0.001) (Figure). Moreover, inducible ischemia was associated with cardiovascular death for both women (hazard ratio HR 1.92; 95% confidence interval CI: 1.12–2.74; p=0.04) and men (HR 2.71; 95% confidence interval CI: 1.98–4.41; p<0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR, presence of inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85; 95% confidence interval CI: 1.18–2.92; p=0.008) and men (HR 3.55; 95% confidence interval CI: 2.73–4.63; p<0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65–3.01; p<0.01) but not for women (p=0.11). Conclusion Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients of either sex presenting with inducible ischemia. However, inducible ischemia is an independent predictor of a higher incidence of CV mortality only in men. Kaplan-Meier curves for MACE in each sex Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
F Sanguineti ◽  
M Kinnel ◽  
V Landon ◽  
P Garot ◽  
...  

Abstract Background Recent data suggest that patients with HFrEF (heart failure with reduced left ventricular ejection fraction (LVEF) <40%) referred for stress cardiovascular magnetic resonance (CMR) may have a less optimal haemodynamic response to intravenous vasodilator. The prognostic value of stress CMR has been poorly investigated in this population. Purpose To assess the safety and the prognostic value of vasodilator stress perfusion CMR in patients with HFrEF. Material Between 2008 and 2018, we prospectively included consecutive patients with HFrEF referred for vasodilator stress perfusion CMR with dipyridamole. HFrEF was defined by a previous history of HF and known LVEF <40%. All patients with LVEF ≥40% measured by CMR were excluded. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined by cardiovascular death or nonfatal myocardial infarction (MI). The secondary endpoint was a composite outcome of cardiovascular death or rehospitalization for acute HF defined by the use of intravenous diuretics. The safety of the stress perfusion CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR. Results Of 1084 patients with HFrEF (65±11 years, median LVEF 34.6±4.9%), 1049 (97%) completed the CMR protocol and among those 952 (91%) completed the follow-up (median 5.6±2.4 years). Reasons for failure to complete CMR included declining participation (n=11), renal failure (n=9), intolerance to stress agent (n=8), claustrophobia (n=4) and poor gating (n=3). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Among patients who underwent CMR, 600 (57%) were diagnosed with MI defined by LGE. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.8%) than those with ischemia and without LGE (9.4%), or those with both ischemia and LGE (12.0%; p<0.001 for all). Using Kaplan-Meier analysis, the presence of inducible ischemia and LGE were significantly associated with the occurrence of MACE (hazard ratio [HR], 2.46 [95% CI, 1.69–3.59]; p<0.001) (Figure). In multivariable stepwise Cox regression including clinical characteristics and CMR, the inducible ischemia was an independent predictor of a higher incidence of MACE at follow-up (adjusted HR, 2.26 [95% CI, 1.52–3.35]; p<0.001). However, there was no significant difference between patients with or without ischemia for the secondary outcome (p=0.28). Conclusions Stress CMR is safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients with HFrEF. Kaplan-Meier curves for MACE Funding Acknowledgement Type of funding source: None


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kinnel ◽  
T Pezel ◽  
T Hovasse ◽  
P Garot ◽  
T Unterseeh ◽  
...  

Abstract Background Obesity is a growing public health problem. Given the impact of obesity on cardiovascular disease, methods to effectively risk stratify obese patients are needed. Current methods for the detection of myocardial ischemia by single photon emission computed tomography or stress echocardiography remain limited in obese patients. Stress cardiac magnetic resonance (CMR) may be a powerful alternative, but its feasibility and prognostic value in the obese population has not been specifically evaluated. Objectives This study sought to determine feasibility and prognostic value of vasodilator stress perfusion CMR in morbid obese patients with body mass index (BMI) ≥40 kg/m2. Methods Consecutive patients with a BMI ≥40 kg/m2 and without known coronary artery disease (CAD) referred for vasodilating stress CMR were followed for major adverse cardiovascular events (MACE), defined as cardiac death, non-fatal myocardial infarction or stroke. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR. Results Of 452 obese patients, 444 (98%) completed the CMR protocol with good diagnostic imaging quality; among those, 404 (91%) completed the follow-up (mean 5.6±2.2 years). Participants averaged 59±11 years in age with 44% of men (mean BMI 43.9±3.8 kg/m2, maximum weight 210 kg and maximum BMI 67.1 kg/m2). Stress CMR was well tolerated without severe adverse event. Reasons for failure to complete CMR included claustrophobia (n=3), declining participation (n=4) and intolerance to stress agent (n=1). Patients without inducible ischemia or LGE experienced a substantially lower annual rate of MACE (3.3% vs. 12.4% for those with ischemia and vs. 11.2% for those with ischemia and LGE). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the absence of inducible ischemia was independently associated with a lower incidence of MACE at follow-up (hazard ratio 0.20; 95% confidence interval: 0.11 to 0.36; p<0.001) (Figure) and cardiac death (hazard ratio 0,11 95% confidence interval: 0.02 to 0.63; p=0,013); cardiac death was reduced in the group with no late gadolinium enhancement (hazard ratio 0,12 95% confidence interval: 0.02 to 0.66; p<0.015). When patients with early coronary revascularization (within 30 days of CMR) were censored on the day of revascularization, both presence of inducible ischemia and ischemia extent per segment maintained a strong association with MACE. Using Kaplan-Meier analyses, myocardial ischemia identified future CV events/survival (p<0.001), and this finding was similar in men and women (p=0.16). Conclusion Stress CMR is feasible and of high prognostic value in morbid obese patients, with a very low negative event rate at 5 years in patients without ischemia or infarction as opposed to patients with inducible ischemia and/or presence of myocardial infarct.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Theo Pezel ◽  
Philippe Garot ◽  
Marine Kinnel ◽  
Valentin Landon ◽  
Thomas Hovasse ◽  
...  

Introduction: Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men. Hypothesis: To test the hypothesis that stress CMR can provide robust prognostic value in women to the same extent as in men. Methods: Consecutive patients referred for stress CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE): cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. Results: Of 3436 patients referred for stress CMR in a single French center, 3322 completed the CMR protocol (60±12yrs, 57%men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4±0.2 years). Reasons for failure to complete CMR included renal failure (n=29), claustrophobia (n=26), poor gating (n=22), intolerance to stress agent (n=19) and declining participation (n=18). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36; 95% CI[1.54-3.62]; p <0.001) and men (HR 3.57; 95% CI[2.75-4.64]; p <0.001). Moreover, inducible ischemia was associated with cardiovascular death for both women (HR 1.92; 95% CI[1.12-2.74]; p =0.04) and men (HR 2.71; 95%CI[1.98-4.41]; p <0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR, inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85; 95% CI[1.18-2.92]; p =0.008) and men (HR 3.55; 95% CI[2.73-4.63]; p <0.001). Conclusions: Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE and cardiovascular mortality in patients of either sex presenting with inducible ischemia.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
M Kinnel ◽  
T Hovasse ◽  
P Garot ◽  
T Unterseeh ◽  
...  

Abstract Background The World's ageing population with a life expectancy that is steadily increasing raises the question of the benefit of screening for coronary artery disease (CAD) in very old patients with high risk of CAD. Current guidelines discourage the performance of stress testing in asymptomatic elderly. Purpose To assess the prognostic value of vasodilator stress perfusion cardiac magnetic resonance (CMR) in elderly patients aged >75 years without previous known CAD. Material Consecutive elderly patients >75 years without known CAD referred for vasodilator stress perfusion CMR were followed for major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction or stroke. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR beyond traditional clinical risk indexes. Results Of 754 elderly high risk patients (82.0±3.9 years, 48.4% men), 747 (99%) completed the CMR protocol, and among those 659 (88.2%) completed the follow-up (median follow-up 5.7±2.5 years). Reasons for failure to complete CMR included claustrophobia (n=3), declining participation (n=2) and intolerance to stress agent (n=2). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual rate of MACE (5.5% vs. 9.9% for those with ischemia and vs. 6.9% for those with ischemia and/or LGE). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the absence of inducible ischemia was an independent predictor of a lower incidence of MACE at follow-up (hazard ratio 0.46; 95% confidence interval: 0.34 to 0.62; p<0.001) (Figure 1A) and all-cause mortality (hazard ratio 0.67; 95% confidence interval: 0.45 to 0.97; p=0.037). When patients with early coronary revascularization (within 30 days of CMR) were censored on the day of revascularization, both presence of inducible ischemia and ischemia extent per segment maintained a strong association with MACE. Using Kaplan-Meier analyses, the presence of myocardial ischemia identified the occurrence of future CV events (p<0.001). Moreover, the absence of inducible ischemia was a predictor of a lower incidence of MACE less significant in men than in women (p<0.01) (Figure 1B). Conclusion Stress CMR is safe and has discriminative prognostic value in very elderly patients, with a very low negative event rate in patients without ischemia or infarction. Among elderly patients without known CAD, the presence of myocardial ischemia on vasodilator stress CMR was predictive of future CV event or death.


2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
P Garot ◽  
M Kinnel ◽  
V Landon ◽  
T Hovasse ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Several studies have demonstrated the consistently high prognostic value of stress perfusion cardiovascular magnetic resonance (CMR). This prognostic value in patients with known myocardial infarction (MI) is poorly described. There remains some skepticism about the capacity of stress CMR in predicting the clinical outcome due to the technical challenge during image analysis causes by myocardial scar. PURPOSE The aim of our study was to assess the prognostic value of vasodilator stress perfusion CMR in patients with known MI. METHODS We prospectively included consecutive patients with known MI referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. RESULTS Of 1602 patients with known MI (68 ± 17 years, 78% men), 1556 (97%) completed the CMR protocol, and among those 1401 (90%) completed the follow-up (median follow-up 5.7 (3.9–7.6) years). Reasons for failure to complete CMR included ECG-gating problems (n = 13), intolerance to stress agent (n = 12), renal failure (n = 12), declining participation (n = 4) and claustrophobia (n = 5). Stress CMR was well tolerated without occurrence of death or severe adverse event. Patients without inducible ischemia experienced a substantially lower annual event rate of MACE (3.1%) than those with 1 or 2 segments of ischemia (4.5%), than those with 3 to 5 segments of ischemia (21.5%), than those with 6 or more segments of ischemia (45.7%, for all p &lt; 0.01). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 3.52; 95% confidence interval CI: 2.67 – 4.65; p &lt; 0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 2.84; 95% CI: 2.14 to 3.78; p &lt; 0.001). CONCLUSION Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE in patients with known MI. Abstract Figure. Kaplan-Meier curves for MACE


Author(s):  
Théo Pezel ◽  
Thierry Unterseeh ◽  
Philippe Garot ◽  
Thomas Hovasse ◽  
Francesca Sanguineti ◽  
...  

Background: Although the benefit of coronary revascularization in patients with stable coronary disease is debated, data assessing the potential interest of stress cardiovascular magnetic resonance (CMR) to guide coronary revascularization are limited. We aimed to assess the long-term prognostic value of stress CMR-related coronary revascularization in consecutive patients from a large registry. Methods: Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range, 5.0–8.0) included all consecutive patients referred for stress CMR. CMR-related coronary revascularization was defined by any coronary revascularization performed within 90 days after CMR. The primary outcome was all-cause death based on the National Death Registry. Results: Among the 31 762 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2679 (8.4%) died at 206 453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement by CMR were associated with death (both P <0.001). In multivariable Cox regression, inducible ischemia and late gadolinium enhancement were independent predictors of death (hazard ratio, 1.61 [99.5% CI, 1.41–1.84]; hazard ratio, 1.62 [99.5% CI, 1.41–1.86], respectively; P <0.001). In the overall population, CMR-related coronary revascularization was an independent predictor of greater survival (hazard ratio, 0.58 [99.5% CI, 0.46–0.74]; P <0.001). In 1680, 1:1 matched patients using a limited number of variables (840 revascularized, 840 nonrevascularized), CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (≥6 segments, P <0.001) but showed no benefit in patients with mild or moderate ischemia (<6 segments, P =0.109). Using multivariable analysis in the propensity-matched population, CMR-related revascularization remained an independent predictor of a lower incidence of all-cause mortality (hazard ratio, 0.66 [99.5% CI, 0.54–0.80], P <0.001). Conclusions: In this large observational series of consecutive patients, stress perfusion CMR had important incremental long-term prognostic value to predict death over traditional risk factors. CMR-related revascularization was associated with a lower incidence of death in patients with severe ischemia.


2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
P Garot ◽  
M Kinnel ◽  
V Landon ◽  
T Hovasse ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND  Several studies have demonstrated the consistently high diagnostic and prognostic value of stress perfusion imaging with cardiovascular magnetic resonance (CMR). The feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation (AF) is unknown, because most studies have excluded arrhythmic patients from analysis.  PURPOSE  The aim of our study was to assess the technical feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF.  METHODS  Between 2008 and 2018, we prospectively included consecutive patients with AF referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction (MI). The secondary outcome was all-cause mortality. The diagnosis of AF was confirmed on 12-lead ECG before and after CMR, and patients with sinus rhythm during CMR were excluded. In the CMR protocol, to limit AF-related artifacts on cine images, an arrhythmia rejection algorithm, or real-time sequences were used. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.  RESULTS  Of 639 patients with AF and suspected or stable chronic CAD (72 ± 9 years, 77% men), 602 (94%) completed the CMR protocol, and among those 538 (89%) completed the follow-up (median follow-up 5.1 (3.3–7.1) years). Reasons for failure to complete CMR included AF-related ECG-gating problems (n = 17), intolerance to stress agent (n = 7), renal failure (n = 6), declining participation (n = 4) and claustrophobia (n = 3).  Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.2%) than those with ischemia and without LGE (8.9%), or those with both ischemia and LGE (9.8%; p &lt; 0.001 for all). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 7.56 ; 95% confidence interval CI: 4.86 – 11.80; p &lt; 0.001) (Figure).  In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 5.88 ; 95% CI: 3.70 - 10.07; p &lt; 0.001) and all-cause mortality (HR 2.51 ; 95% CI: 1.47 - 4.17; p &lt; 0.001).  CONCLUSION  Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE and all-cause mortality in patients with AF. Abstract Figure. Kaplan-Meier curves for MACE


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
F Sanguineti ◽  
M Kinnel ◽  
G Bonnet ◽  
V Landon ◽  
...  

Abstract Background Several studies have demonstrated the consistently high diagnostic and prognostic value of stress perfusion imaging with cardiovascular magnetic resonance (CMR). The feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation (AF) is unknown, because most studies have excluded arrhythmic patients from analysis. Purpose The aim of our study was to assess the technical feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF. Material Between 2008 and 2018, we prospectively included consecutive patients with AF referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction (MI). The secondary outcome was all-cause mortality. The diagnosis of AF was confirmed on 12-lead ECG before and after CMR, and patients with sinus rhythm during CMR were excluded. In the CMR protocol, to limit AF-related artifacts on cine images, an arrhythmia rejection algorithm, or real-time sequences were used. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. Results Of 639 patients with AF and suspected or stable chronic CAD (72±9 years, 77% men), 602 (94%) completed the CMR protocol, and among those 538 (89%) completed the follow-up (median follow-up 5.1 (3.3–7.1) years). Reasons for failure to complete CMR included AF-related ECG-gating problems (n=17), intolerance to stress agent (n=7), renal failure (n=6), declining participation (n=4) and claustrophobia (n=3). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.2%) than those with ischemia and without LGE (8.9%), or those with both ischemia and LGE (9.8%; p&lt;0.001 for all). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 7.56; 95% confidence interval CI: 4.86–11.80; p&lt;0.001) (Figure). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 5.88; 95% CI: 3.70–10.07; p&lt;0.001) and all-cause mortality (HR 2.51; 95% CI: 1.47–4.17; p&lt;0.001). Conclusion Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE and all-cause mortality in patients with AF. Kaplan-Meier curves for MACE Funding Acknowledgement Type of funding source: None


2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
T Unterseeh ◽  
P Garot ◽  
T Hovasse ◽  
F Sanguineti ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND While the benefit of coronary revascularization in patients with stable coronary artery disease (CAD) is debated, data assessing the potential interest of stress CMR to guide coronary revascularization are limited. PURPOSE To assess the long-term prognostic value of stress CMR-related coronary revascularization in consecutive patients from a large registry. METHODS Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0-8.0) included all consecutive patients referred for stress CMR. Stress CMR-related coronary revascularization was defined by any coronary revascularization performed within 90 days after CMR. The primary outcome was all-cause death based on the electronic National Death Registry. RESULTS Among the 31,752 consecutive patients (mean age 63.7 ± 12.1 years and 65.7% males), 2,679 (8.4%) died at 206,453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement (LGE) by CMR were associated with death (both p &lt; 0.001). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of death (HR = 1.61; 99.5%CI 1.41-1.84; HR = 1.62; 99.5%CI 1.41-1.86, respectively; p &lt; 0.001). CMR-related coronary revascularization was an independent predictor of greater survival (HR: 0.66; 99.5%CI: 0.52-0.84; p &lt; 0.001). CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (p &lt; 0.001), but showed no benefit in patients with mild or moderate ischemia (p = 0.109). CONCLUSIONS In this large observational series of consecutive patients, stress perfusion CMR had important incremental long-term prognostic value to predict death over traditional risk factors. CMR-related revascularization was associated with a lower incidence of death in patients with severe ischemia.


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