200Vasodilator stress perfusion CMR is feasible and has prognostic value in morbid obese patients without known CAD

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.

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

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2020.10.019 ◽

2021 ◽

Vol 13 (1) ◽

pp. 13-14

Author(s):

T. Pezel ◽

P. Garot ◽

M. Kinnel ◽

V. Landon ◽

T. Hovasse ◽

...

Keyword(s):

Myocardial Infarction ◽

Prognostic Value ◽

Vasodilator Stress ◽

Stress Perfusion ◽

Perfusion Cmr

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

European Heart Journal ◽

10.1093/eurheartj/ehz745.0170 ◽

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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Feasibility and Prognostic Value of Vasodilator Stress Perfusion CMR in Patients With Atrial Fibrillation

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2020.07.041 ◽

2020 ◽

Cited By ~ 1

Author(s):

Théo Pezel ◽

Francesca Sanguineti ◽

Marine Kinnel ◽

Valentin Landon ◽

Solenn Toupin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Prognostic Value ◽

Vasodilator Stress ◽

Stress Perfusion ◽

Perfusion Cmr

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271Feasibility and prognostic value of vasodilator stress perfusion CMR in elderly patients > 75 years without known CAD

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez101.004 ◽

2019 ◽

Vol 20 (Supplement_2) ◽

Cited By ~ 1

Author(s):

T Pezel ◽

M Kinnel ◽

T Hovasse ◽

P Garot ◽

T Unterseeh ◽

...

Keyword(s):

Elderly Patients ◽

Prognostic Value ◽

Vasodilator Stress ◽

Stress Perfusion ◽

Perfusion Cmr

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Feasibility and prognostic value of stress-perfusion CMR in obesity

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-14-s1-o2 ◽

2012 ◽

Vol 14 (S1) ◽

Author(s):

Ravi Shah ◽

Otavio R Coelho-Filho ◽

Tomas G Neilan ◽

Bobby Heydari ◽

Ron Blankstein ◽

...

Keyword(s):

Prognostic Value ◽

Stress Perfusion ◽

Perfusion Cmr

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Abstract 3093: Long Term Prognostic Value of Stress Perfusion CMR and Late Gadolinium Enhanced CMR for The Prediction of Major Adverse Cardiac Events.

Circulation ◽

10.1161/circ.116.suppl_16.ii_693-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Tairo Kurita ◽

Hajime Sakuma ◽

Katsuya Onishi ◽

Motonori Nagata ◽

Takeshi Takamura ◽

...

Keyword(s):

Myocardial Infarction ◽

Prognostic Value ◽

Prognostic Significance ◽

Hazard Ratio ◽

Stress Perfusion ◽

Adverse Cardiovascular Event ◽

Number Of Patients ◽

High Hazard Ratio ◽

Lge Cmr ◽

Perfusion Cmr

Background: Combined stress myocardial perfusion (S-PERF) and late gadolinium enhanced (LGE) CMR allows for the detection of myocardial ischemia and infarction. However, prognostic values of S-PERF and LGE CMR have not been determined in a large number of patients. In this study we determined the prognostic significance of combined S-PERF and LGE CMR study. Methods: We studied 826 patients who underwent both stress-rest perfusion CMR and LGE CMR. Stress-induced ischemia on S-PERF CMR and myocardial infarction on LGE CMR were qualitatively determined. Major adverse cardiovascular event (MACE) was defined as cardiac death, non-fatal acute myocardial infarction, heart failure on admission. Patients who underwent revascularization within 2 month after CMR were excluded. Results: During a median follow-up time of 34 months (range, 2 to 96 months), event-free survival rate was 89% in S-PERF(−)/LGE(−), 64% in S-PERF(−)/LGE(+), 49% in S-PERF(+)/LGE(−), and 38% in S-PERF(+)/LGE(+) group (P<0.001 between any combinations). Abnormality on S-PERT/LGE CMR was a significant negative prognostic factor of MACE with a high hazard ratio of 7.0 (95% CI 3.9–12.7, P<0.001). While LGE also predicted patients outcome, its hazard ratio (1.42, 95% CI 1.22–1.67, P<0.001) was lower than that by S-PERT/LGE CMR (FIgure 1 ). Normal S-PERF/LGE CMR was associated with lower event rate per year (1.6%) as compared with that by normal LGE alone (4.3%, P<0.001). Conclusions: Combined S-PERF and LGE CMR can provide improved prognostic value when compared with LGE CMR alone in patients with known or suspected coronary artery disease. Patients with normal S-PERF and LGE CMR were at low risk of adverse outcome. Figure 1: Kaplan- Meler survival distributions based on presence of LGE alone (left) and any abnormality on S-PER/LGE CMR (right)

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