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.

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 < 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.

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 < 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 < 0.001). CMR-related coronary revascularization was an independent predictor of greater survival (HR: 0.66; 99.5%CI: 0.52-0.84; p < 0.001). CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (p < 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.

733: The Prognostic Value of E-Cadherin, Alpha-, and Beta-Catenin in Invasive Bladder Cancer Patients: Long Term Follow-Up Study

2004 ◽  
Vol 171 (4S) ◽  
pp. 194-195
Author(s):  
Kyoichi Tomita ◽  
Haruki Kume ◽  
Keishi Kashibuchi ◽  
Satoru Muto ◽  
Shigeo Horie ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Prognostic Value ◽  
Invasive Bladder Cancer ◽  
Beta Catenin ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
E Cadherin

scholarly journals Arrhythmia Burden from Implantable Device Interrogation during Long-Term Follow-Up in LVAD Patients

2021 ◽  
Vol 40 (4) ◽  
pp. S395
Author(s):  
H. Vidula ◽  
A. Chen ◽  
S. Tankut ◽  
A. Yoruk ◽  
J. Alexis ◽  
...  
Keyword(s):  
Implantable Device ◽  
Long Term Follow Up

Lack of Prognostic Value of Normalized Integrated Backscatter Analysis of Myocardium in Patients with Thalassemia Major: A Long-Term Follow-Up Study

2005 ◽  
Vol 22 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Zoltan Jambrik ◽  
Giorgio Derchi ◽  
Eugenio Picano ◽  
Lamia Ait-Ali ◽  
Gianluca Forni ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Thalassemia Major ◽  
Integrated Backscatter ◽  
Follow Up Study ◽  
Long Term Follow Up

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.

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