scholarly journals Safety, feasibility and prognostic value of stress perfusion CMR in patients with pacemaker

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
J Lacotte ◽  
S Toupin ◽  
P Garot ◽  
T Hovasse ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Coronary Revascularization ◽  
Cardiovascular Death ◽  
Stress Perfusion ◽  
Major Adverse Cardiovascular Events ◽  
Inducible Ischemia ◽  
Mr Conditional ◽  
Stress Cmr ◽  
Perfusion Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Several studies have shown the excellent prognostic value of stress cardiovascular magnetic resonance (CMR). However, its prognostic value in patients with pacemaker (PM) remains unknown because most studies excluded PM patients. PURPOSE This study aimed to assess the prognostic value of vasodilator stress perfusion CMR in patients with PM. METHODS Consecutive patients with MR-conditional pacemakers referred for stress perfusion CMR at 1.5 T were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Cox regressions analyses were performed to determine the prognostic value of CMR-parameters. The quality of CMR was rated by two observers blinded to clinical details. Data on pacemaker and leads were collected pre- and post-CMR. RESULTS Of 224 patients who completed the stress CMR protocol, 2 patients had inconclusive stress CMR due to artefact and 203 patients (72.9% male, mean age 71.4 ± 8.7 years) completed the follow-up (median [interquartile range], 7.0 [5.2-7.3] years). Among those, 23 experienced a MACE (11.3%). Stress CMR was well tolerated with no major adverse events. All scans were completed successfully with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.1% of segments. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.80 [95% CI, 4.63-30.30]; and HR: 6.74 [95% CI, 2.47-18.40], both p < 0.001; respectively). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 5.24 [95% CI, 2.61-14.40]; and HR: 2.98 [95% CI, 2.25-4.02]; both p < 0.001; respectively). In patients with ischemia, CMR-related coronary revascularization showed no benefit in reducing MACE (p = 0.25). CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.

Abstract 13475: Stress Perfusion Cardiovascular Magnetic Resonance Provides Strong Long-term Prognostic Value to Cardiac Events Irrespective of Patient Sex

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Theo Pezel ◽  
Philippe Garot ◽  
Marine Kinnel ◽  
Valentin Landon ◽  
Thomas Hovasse ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Stress Perfusion ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Inducible Ischemia ◽  
Stress Cmr

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.

Abstract 13477: Feasibility and Prognostic Value of Vasodilator Stress Perfusion Cardiovascular Magnetic Resonance in Patients With Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Theo Pezel ◽  
Francesca Sanguineti ◽  
Marine Kinnel ◽  
Valentin Landon ◽  
Thomas Hovasse ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Major Adverse Cardiovascular Events ◽  
Chronic Coronary Artery Disease ◽  
Inducible Ischemia ◽  
Perfusion Cmr

Introduction: Because most studies have excluded arrhythmic patients, the prognostic value of stress perfusion CMR in patients with atrial fibrillation (AF) is unknown. Hypothesis: To assess the feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF. Methods: Between 2008 and 2018, consecutive patients with suspected or stable chronic coronary artery disease (CAD) and AF referred for vasodilator stress perfusion CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or non-fatal myocardial infarction. The diagnosis of AF was defined by 12-lead electrocardiogram before and after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. Results: Of 639 patients (72±9 years, 77% men), 602 (94%) completed the CMR protocol, and 538 (89%) completed the follow-up (median 5.1 years); 80 had a MACE. Stress CMR was well tolerated. Using Kaplan-Meier analysis, the presence of ischemia or LGE was associated with the occurrence of MACE (HR 7.56; 95% CI: 4.86-11.80 and HR 2.41; 95% CI: 1.55-3.74 respectively; for both p <0.001). In a multivariable Cox regression including clinical and CMR indexes, the presence of ischemia or LGE was an independent predictor of MACE (HR 5.98; 95% CI: 3.68-9.73 and HR 2.61; 95% CI: 1.89-3.60 respectively; for both p <0.001). Conclusions: In patients with AF, stress perfusion CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE.

Safety and prognostic value of vasodilator stress CMR in patients with heart failure and reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
F Sanguineti ◽  
M Kinnel ◽  
V Landon ◽  
P Garot ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Value ◽  
Cardiovascular Death ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Kaplan Meier ◽  
Stress Cmr ◽  
Perfusion Cmr

Abstract Background Recent data suggest that patients with HFrEF (heart failure with reduced left ventricular ejection fraction (LVEF) &lt;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 &lt;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&lt;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&lt;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&lt;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

scholarly journals Prognostic value of vasodilator stress perfusion CMR in patients with known myocardial infarction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
P Garot ◽  
M Kinnel ◽  
V Landon ◽  
T Hovasse ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Cox Regression ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Kaplan Meier ◽  
Stress Cmr ◽  
Perfusion Cmr

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

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 ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Prognostic Value ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Stress Cmr ◽  
Perfusion Cmr

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 &lt; 0.001) and men (HR 3.57 ; 95% confidence interval CI: 2.75 – 4.64; p &lt; 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 &lt; 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 &lt; 0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65 – 3.01; p &lt; 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.

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

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
F Sanguineti ◽  
M Kinnel ◽  
V Landon ◽  
P Garot ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Prognostic Value ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Kaplan Meier ◽  
Stress Cmr ◽  
Perfusion Cmr

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&lt;0.001) and men (HR 3.57; 95% confidence interval CI: 2.75–4.64; p&lt;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&lt;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&lt;0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65–3.01; p&lt;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

scholarly journals Long-term prognostic value of stress CMR-related coronary revascularization to predict death: a large registry with > 200,000 patient-years of follow-up

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
T Unterseeh ◽  
P Garot ◽  
T Hovasse ◽  
F Sanguineti ◽  
...  
Keyword(s):  
Lower Incidence ◽  
Prognostic Value ◽  
Cox Regression ◽  
Coronary Revascularization ◽  
Stable Coronary Artery Disease ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Stress Cmr

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.

scholarly journals Prognostic value of pre-hospitalization stress perfusion CMR to predict death in patients hospitalized for COVID-19

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
P Garot ◽  
T Hovasse ◽  
T Unterseeh ◽  
S Champagne ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Stress Perfusion ◽  
Cox Regression Analysis ◽  
Inducible Ischemia ◽  
Funding Sources ◽  
Kaplan Meier ◽  
Stress Cmr ◽  
Perfusion Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Inducible ischemia is a strong marker of vascular vulnerability that may be a key pathogenetic determinant of COVID-19 severity. PURPOSE This study investigated the prognostic value of prior inducible ischemia on stress perfusion CMR to predict death in patients hospitalized for COVID-19. METHODS In an observational study, we retrospectively analyzed consecutive patients referred for stress perfusion CMR within last two years prior to hospitalization for COVID-19. The primary outcome was all-cause death, including in-hospital and post-hospitalisation deaths, based on the electronic national death registry. RESULTS Among the patients referred for stress perfusion CMR, 481 were hospitalized for COVID-19 (mean age =68.4 ± 9.6 years, 61.3% males) and completed the follow-up (median 73[36-101] days). There were 93 (19.3%) all-cause deaths, of which 13.7% were in-hospital and 5.6% post-hospitalisation deaths. Using Kaplan-Meier analysis, age, male gender, hypertension, diabetes, known CAD, the presence of prior inducible ischemia, the number of ischemic segments, the presence of LGE, and LVEF were significantly associated with all-cause death. In multivariable stepwise Cox regression analysis, age (HR: 1.04; 95%CI:1.01-1.07, p = 0.023), hypertension (HR: 2.77; 95%CI:1.71-4.51, p &lt; 0.001), diabetes (HR: 1.72; 95%CI:1.08-2.74, p = 0.022), known CAD (HR: 1.78; 95%CI:1.07-2.94, p = 0.025) and the presence of prior inducible ischaemia  (HR: 2.05; 95%CI:1.27-3.33, p = 0.004) were independent predictors of all-cause death. CONCLUSIONS In COVID-19 patients, prior inducible myocardial ischemia by stress CMR over the last two years preceding the COVID-19 pandemic was independently associated with all-cause in-hospital and post-hospitalisation deaths, suggesting involvement of vasculature and endothelial dysfunction in the severity of COVID-19.

P3094Feasibility and prognostic value of vasodilator stress perfusion CMR in elderly patients > 75 years without known CAD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
M Kinnel ◽  
T Hovasse ◽  
P Garot ◽  
T Unterseeh ◽  
...  
Keyword(s):  
High Risk ◽  
Myocardial Ischemia ◽  
Elderly Patients ◽  
Prognostic Value ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Stress Cmr ◽  
Perfusion Cmr

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.

scholarly journals Prognostic interest of vasodilator stress perfusion cardiovascular magnetic resonance after a first inconclusive stress testing

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
T Unterseeh ◽  
P Garot ◽  
T Hovasse ◽  
M Kinnel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Value ◽  
Stress Testing ◽  
Coronary Revascularization ◽  
Stress Test ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
C Statistic ◽  
Traditional Risk Factors ◽  
Stress Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND While current guidelines recommend to perform a noninvasive test to detect coronary artery disease, stress tests are deemed inconclusive in almost a third of cases. The strategy for risk stratification after inconclusive stress testing is not well standardized. PURPOSE To assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters and CMR-based coronary revascularization in patients after inconclusive stress testing. METHODS Between 2008 and 2020, consecutive patients with a first inconclusive stress test referred for vasodilator stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. CMR-related coronary revascularization was defined as any revascularisation occurring within 90 days after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter. RESULTS Of 1,563 patients who completed the CMR protocol, 1,402 patients (66.7% male, mean age 69.5 ± 11.0 years) completed the follow-up (median[interquartile range], 6.5 [5.6-7.5] years); 197 experienced a MACE (14.1%). Stress CMR was well tolerated without severe adverse events. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 2.88 [95%CI, 2.18-3.81]; and HR: 1.46 [95%CI, 1.16-1.89], both p &lt; 0.001; respectively). In multivariable Cox regression, the presence and extent of inducible ischemia were independent predictors of a higher incidence of MACE (HR: 2.53 [95%CI, 1.89-3.40]; and HR: 1.58 [95%CI, 1.47-1.71]; both p &lt; 0.001; respectively). After adjustment, the extent of inducible ischemia showed the best improvement in model discrimination above traditional risk factors (C-statistic 0.75 [95%CI: 0.69-0.81] with C-statistic improvement: 0.12). The study showed no benefit of CMR-related coronary revascularization in reducing MACE. CONCLUSION In patients with a first inconclusive stress test, stress CMR has good prognostic value to predict MACE offering an incremental prognostic value over traditional risk factors.

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