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 < 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 < 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.

scholarly journals Prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance after inconclusive stress testing

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Théo Pezel ◽  
Thierry Unterseeh ◽  
Philippe Garot ◽  
Thomas Hovasse ◽  
Marine Kinnel ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Stress Testing ◽  
Coronary Revascularization ◽  
Stress Test ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
C Statistic ◽  
Traditional Risk Factors ◽  
Stress Cmr

Abstract Background While current guidelines recommend noninvasive testing to detect coronary artery disease, stress tests are deemed inconclusive in a quarter of cases. The strategy for risk stratification after inconclusive stress testing is not well standardized. To assess the prognostic value of vasodilator 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 non-CMR 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 1563 patients who completed the CMR protocol, 1402 patients (66.7% male, 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%). Vasodilator 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 < 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 < 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 suggested no benefit of CMR-related coronary revascularization in reducing MACE. Conclusions In patients with a first non-CMR inconclusive stress test, vasodilator stress CMR has good prognostic value to predict MACE offering an incremental prognostic value over traditional risk factors.

scholarly journals Long-term prognostic value of stress CMR in patients with history of percutaneous coronary intervention

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
T Hovasse ◽  
M Kinnel ◽  
F Sanguineti ◽  
S Champagne ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Prognostic Value ◽  
Coronary Revascularization ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Percutaneous Coronary ◽  
History Of ◽  
Stress Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Recurrence of cardiovascular (CV) events remains a substantial cause of mortality and morbidity among patients with previous coronary revascularization. PURPOSE The aim was to assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters and CMR-based revascularization in patients with history of percutaneous coronary intervention (PCI). METHODS Between 2011 and 2014, consecutive patients with history of PCI referred for stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Patients with prior coronary artery bypass graft were excluded. CMR-related coronary revascularization was defined as any revascularization occurring within 90 days after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter. RESULTS Of 1,762 patients who completed the CMR protocol, 1,624 patients (81.7% male, mean age 67.9 ± 10.4 years) completed the follow-up (median [interquartile range], 6.7 [5.6–7.3] years); 251 experienced a MACE (15.5%). Stress CMR was well tolerated. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 2.70 [95%CI, 2.11–3.46], p &lt; 0.001; and HR: 1.52 [95%CI, 1.16–1.99], p = 0.002; respectively). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 2.83 [95%CI, 2.20–3.64]; p &lt; 0.001; and HR: 1.42 [95%CI, 1.06–1.91]; p = 0.012; respectively). CMR-related coronary revascularization was associated with a lower incidence of MACE, even after adjustment. CONCLUSIONS Stress CMR and CMR-related revascularization were independently associated with MACE in patients with history of PCI.

Additional prognostic value of vasodilator stress CMR in patients with inconclusive stress test to detect coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
G Bonnet ◽  
P Garot ◽  
A Asselin ◽  
T Unterseeh ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Prognostic Value ◽  
Stress Test ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Artery Disease ◽  
Stress Cmr ◽  
Cluster 2 ◽  
Perfusion Cmr

Abstract Background Guidelines recommend performing a non-invasive testing for ischemia to diagnose coronary artery disease (CAD). However, these tests are frequently inconclusive (25%). This population has been poorly studied because of its heterogeneity. In such cases, stress cardiac magnetic resonance (CMR) may be useful to improve diagnostic certainty. To date, no study has evaluated the prognostic value of stress CMR in these patients presenting with prior inconclusive test. Purpose To assess the additional prognostic value of vasodilator stress perfusion CMR in patients with a first inconclusive stress test to detect CAD. Material Between 2008 and 2018, consecutive patients with inconclusive stress test prospectively referred for vasodilator stress perfusion CMR with dipyridamole were followed for major adverse cardiovascular events (MACE) defined as cardiac death or myocardial infarction. Inconclusive stress test was defined by echocardiography or nuclear stress testing with uncertain conclusion about the diagnosis of CAD. To characterize this population, an unsupervised clustering analysis was performed using 18 variables. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia by stress CMR in each cluster. Results Of 1502 patients with inconclusive stress test (62±12 years, 59% men), 1441 (96%) completed the CMR protocol and 1397 (93%) completed the follow-up (median 5.5±2.3 years). Stress CMR was well tolerated without occurrence of death or severe adverse event. The clustering analysis identified 3 clusters: Cluster 1 (n=524, 35%) had the highest prevalence of previous percutaneous coronary intervention (PCI), the highest presence of myocardial scar on CMR, the lowest LVEF (35±7%) and the highest degree of LV dilatation. Cluster 2 (n=406, 27%) had the highest prevalence of previous coronary artery bypass grafting (CABG), preserved LVEF (54±10%), absence of LV dilatation and rate of male (89%). Cluster 3 (n=572, 38%) had the lowest rate of previous PCI/CABG and of myocardial scar. This cluster gathered the oldest patients (73±11 years), predominantly female (60%), with the highest rate of atrial fibrillation and body mass index. Survival analysis found significant differences across clusters for the occurrence of MACE (p=0.02). Moreover, inducible ischemia was significantly associated with the occurrence of MACE in each cluster (cluster 1, HR 2.28; [95% CI: 1.31–3.99]; p=0.0028; cluster 2, HR 3.37; [95% CI, 1.97–5.75]; p&lt;0.0001; cluster 3, HR 2.73; [95% CI, 1.67–4.46]; p&lt;0.0001). In multivariable Cox regression, inducible ischemia was an independent predictor of a higher incidence of MACE in each cluster (p&lt;0.001). Conclusions Cluster analysis identified 3 different phenotypes of patients with inconclusive stress test that were associated with distinct clinical and prognostic profiles. Within these clusters, CMR stress has an additional prognostic value to predict the occurrence of MACE. Kaplan-Meier for MACE in each cluster Funding Acknowledgement Type of funding source: None

scholarly journals Additional prognostic value of vasodilator stress CMR in patients with inconclusive stress test to detect coronary artery disease

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
G Bonnet ◽  
P Garot ◽  
A Asselin ◽  
T Unterseeh ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Prognostic Value ◽  
Stress Test ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Artery Disease ◽  
Stress Cmr ◽  
Cluster 2 ◽  
Perfusion Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Guidelines recommend performing a non-invasive testing for ischemia to diagnose coronary artery disease (CAD). However, these tests are frequently inconclusive (25%). This population has been poorly studied because of its heterogeneity. In such cases, stress cardiac magnetic resonance (CMR) may be useful to improve diagnostic certainty. To date, no study has evaluated the prognostic value of stress CMR in these patients presenting with prior inconclusive test. PURPOSE To assess the additional prognostic value of vasodilator stress perfusion CMR in patients with a first inconclusive stress test to detect CAD. METHODS Between 2008 and 2018, consecutive patients with inconclusive stress test prospectively referred for vasodilator stress perfusion CMR with dipyridamole were followed for major adverse cardiovascular events (MACE) defined as cardiac death or myocardial infarction. Inconclusive stress test was defined by echocardiography or nuclear stress testing with uncertain conclusion about the diagnosis of CAD. To characterize this population, an unsupervised clustering analysis was performed using 18 variables. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia by stress CMR in each cluster. RESULTS Of 1502 patients with inconclusive stress test (62 ± 12 years, 59% men), 1441 (96%) completed the CMR protocol and 1397(93%) completed the follow-up (median 5.5 ± 2.3 years). Stress CMR was well tolerated without occurrence of death or severe adverse event. The clustering analysis identified 3 clusters: Cluster 1 (n = 524, 35%) had the highest prevalence of previous percutaneous coronary intervention (PCI), the highest presence of myocardial scar on CMR, the lowest LVEF(35 ± 7%) and the highest degree of LV dilatation. Cluster 2 (n = 406, 27%) had the highest prevalence of previous coronary artery bypass grafting (CABG), preserved LVEF(54 ± 10%), absence of LV dilatation and rate of male(89%). Cluster 3 (n = 572, 38%) had the lowest rate of previous PCI/CABG and of myocardial scar. This cluster gathered the oldest patients (73 ± 11 years), predominantly female (60%), with the highest rate of atrial fibrillation and body mass index. Survival analysis found significant differences across clusters for the occurrence of MACE (p = 0.02). Moreover, inducible ischemia was significantly associated with the occurrence of MACE in each cluster (cluster 1, HR 2.28; [95%CI: 1.31-3.99]; p = 0.0028; cluster 2, HR 3.37; [95%CI, 1.97-5.75]; p &lt; 0.0001; cluster 3, HR 2.73; [95%CI, 1.67-4.46]; p &lt; 0.0001). In multivariable Cox regression, inducible ischemia was an independent predictor of a higher incidence of MACE in each cluster (p &lt; 0.001). CONCLUSIONS Cluster analysis identified 3 different phenotypes of patients with inconclusive stress test that were associated with distinct clinical and prognostic profiles. Within these clusters, CMR stress has an additional prognostic value to predict the occurrence of MACE. Abstract Figure. Kaplan-Meier for MACE in each cluster

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 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 &lt; 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 &lt; 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 13471: Additional Prognostic Value of Vasodilator Stress Cardiovascular Magnetic Resonance in Patients With Inconclusive Stress Test to Detect Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Theo Pezel ◽  
Guillaume Bonnet ◽  
Francesca Sanguineti ◽  
Marine Kinnel ◽  
Anouk Asselin ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Stress Test ◽  
Multivariable Analysis ◽  
Myocardial Scar ◽  
Major Adverse Cardiovascular Events ◽  
Inducible Ischemia ◽  
Artery Disease ◽  
Stress Cmr

Introduction: Non-invasive testing for ischemia to diagnose coronary artery disease(CAD) are frequently inconclusive(25%). Hypothesis: To assess the prognostic value of stress CMR in patients with a first inconclusive stress test. Methods: Between 2008 and 2018, consecutive patients with inconclusive stress test, defined by stress echocardiography or nuclear testing with uncertain conclusion, prospectively referred for stress CMR with dipyridamole were followed for major adverse cardiovascular events(MACE): cardiac death or myocardial infarction. An unsupervised clustering analysis was performed. Results: Of 1502 patients (62±12yrs, 59%men), 1397 completed the follow-up (median 5.5±2.3yrs). Three clusters were identified: Cluster 1 (n=524) had the highest prevalence of previous PCI, the highest presence of a myocardial scar defined, the lowest LVEF (35±7%) and the highest LV dilatation. Cluster 2 (n=406) had the highest previous CABG prevalence, preserved LVEF, absence of LV dilatation, and presence of myocardial scar. This cluster comprised predominantly male patients, with the highest rate of hypertension. Cluster 3 (n=572) had the lowest rate of previous PCI/CABG, the lowest rate of myocardial scar, predominantly female, the highest atrial fibrillation rate and body mass index. Survival analysis found significant differences across clusters for the occurrence of MACE (p=0.02). Inducible ischemia was associated with MACE occurrence in each cluster (C1, HR 2.28; 95%CI[1.31-3.99]; p=0.0028; C2, HR 3.37; 95%CI[1.97-5.75]; p<0.0001; C3, HR 2.73; 95%CI[1.67-4.46]; p<0.0001). In multivariable analysis, inducible ischemia predicted MACE in each cluster (p<0.001 for all). Conclusions: Cluster analysis identified 3 different phenotypes with distinct clinical and prognostic profiles. Within these clusters, stress CMR has an additional prognostic value to predict MACE..

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 Change in left atrioventricular coupling index to predict incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA)

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
B Ambale Venkatesh ◽  
T Quinaglia ◽  
S Heckbert ◽  
YOKO Kato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Discrimination Performance ◽  
Left Ventricular ◽  
Ethnic Population ◽  
Ethnic Study ◽  
C Statistic ◽  
Coupling Index ◽  
Traditional Risk Factors

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). PURPOSE Due to the intrinsic physiological relationship between LA and LV, we sought to investigate the prognostic value of a left atrioventricular coupling index (LACI) as well as change in LACI to predict incident AF in a multi-ethnic population. METHODS In the Multi-Ethnic Study of Atherosclerosis (MESA), 1,911 study participants, free of clinically recognized AF and cardiovascular disease at baseline, had LACI assessed with CMR imaging at baseline (Exam 1, 2000–2002), and ten years later (Exam 5, 2010–2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident AF. RESULTS Among the 1,911 participants (mean age 59 ± 9 years and 47.5% male participants), 87 incident AF events occurred over 3.9 ±0.9 years following the second imaging (Exam 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (HR 1.69, 95% CI [1.46-1.96] and HR 1.71, 95% CI [1.50-1.94], respectively; both p &lt; 0.0001). Adjusted models for LACI and ΔLACI showed significant improvement in model discrimination compared to currently used AF risk score model for predicting AF incidence (C-statistic: 0.78 vs. 0.74, and C-statistic: 0.80 vs. 0.74, respectively). The LACI and ΔLACI also showed superior discrimination performance for AF compared to the multivariable model including CHARGE-AF score, and individual LA or LV parameters. CONCLUSIONS Atrioventricular coupling (LACI) and coupling change (ΔLACI) are strong predictors for AF incidence in a multi-ethnic population. Both have incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination power compared to the CHARGE-AF score and to individual LA or LV parameters.

Feasibility and prognostic value of adenosine stress perfusion cardiovascular magnetic resonance in patient with implantable device

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Pavon ◽  
AP Porretta ◽  
D Arangalage ◽  
T Rutz ◽  
S Hugelshofer ◽  
...  
Keyword(s):  
Image Quality ◽  
Prognostic Value ◽  
Stress Test ◽  
Implantable Device ◽  
Adenosine Stress ◽  
Stress Perfusion ◽  
Long Term Follow Up ◽  
Stress Cmr

Abstract Funding Acknowledgements Type of funding sources: None. Background stress CMR has a limited use in patients with implantable device, in order to the possible artefacts due to the metallic component and to the risk of adenosine interaction with cardiac pacing. The aim of the study was to assess the global feasibility and to assess the prognostic value of stress perfusion CMR in patients with implantable device. Materials and Methods we conducted a retrospective single-center longitudinal analysis of consecutive patients with an implantable device referred for stress CMR, performed using a 1.5 Tesla unit (Siemens Healthcare,MAGNETOM Aera, Erlangen-Germany). Protocol was adapted according to current guidelines. Cardiac follow-up [6 months to 7 years] was obtained by medical records of direct contact with patient’s cardiologist referral.  Results 44 patients were enrolled. 34 patients needed a continuous pacing during adenosine stress, that was settled in DOO in 14 (32%) and in VOO in 20 (45%). Device integrity was not compromised by CMR and not competitive atrial or ventricular stimulation was observed during examination. Image quality was good in 95% cases. 26% cases had a perfusion deficit corresponding to a previous scar, while 12% of patients had a positive stress test. All of them needed continuous pacing during stress test and underwent to a coronary angiography who confirmed the coronary stenosis.  In patients without inducible ischemia 2 patients experienced a Non-ST-elevation Myocardial Infarction after 6 and 2 years while no other cardiac symptoms or cardiac hospitalisation was remarkable during follow up. Conclusion adenosine stress CMR in patient who are pacemaker dependent during scanner is feasible, with an overall good image quality, proving an excellent diagnostic and prognostic value in a long term follow up even. Adenosine administration is safe and no the magnetic field interference with the correct functioning of the device have been shown in short or long term follow-up.

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