Abstract 13465: Prognostic Value of Vasodilator Stress Perfusion Cardiovascular Magnetic Resonance in Patients With Known Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Theo Pezel ◽  
Philippe Garot ◽  
Marine Kinnel ◽  
Thomas Hovasse ◽  
Solenn Toupin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Perfusion Cardiovascular Magnetic Resonance ◽  
Stress Cmr

Introduction: 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. Hypothesis: 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 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). 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<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 <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 <0.001). Conclusions: Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE in patients with known MI.

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

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.

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 Feasibility and prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
P Garot ◽  
M Kinnel ◽  
V Landon ◽  
T Hovasse ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Stress Cmr ◽  
Perfusion Cmr

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

Feasibility and prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
F Sanguineti ◽  
M Kinnel ◽  
G Bonnet ◽  
V Landon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Stress Cmr ◽  
Perfusion Cmr

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

Prognostic value of dipyridamole stress perfusion cardiovascular magnetic resonance in elderly patients >75 years with suspected coronary artery disease

2020 ◽  
Author(s):  
Théo Pezel ◽  
Francesca Sanguineti ◽  
Marine Kinnel ◽  
Thomas Hovasse ◽  
Philippe Garot ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Stress Perfusion ◽  
Artery Disease ◽  
Stress Cmr ◽  
Dipyridamole Stress

Abstract Aims  There are only very few data on the prognostic value of stress cardiovascular magnetic resonance (CMR) in elderly people, while life expectancy of the general population is steadily increasing. Therefore, this study aims to assess the prognostic value of vasodilator stress perfusion CMR in elderly &gt;75 years. Methods and results  Between 2008 and 2017, we included consecutive elderly &gt;75 years without known coronary artery disease (CAD) referred for dipyridamole stress CMR. They were followed for the occurrence of major adverse cardiovascular events (MACE) including cardiac death or non-fatal myocardial infarction. Univariate and multivariate analyses were performed to determine the prognostic value of ischaemia or late gadolinium enhancement. Of 754 elderly individuals (82.0 ± 3.9 years, 48.4% men), 659 (87.4%) completed the follow-up with median follow-up of 4.7 years. Using Kaplan–Meier analysis, the presence of myocardial ischaemia was associated with the occurrence of MACE [hazard ratio (HR) 5.38, 95% confidence interval (CI): 3.56–9.56; P &lt; 0.001]. In a multivariable Cox regression including clinical characteristics and CMR indexes, inducible ischaemia was an independent predictor of a higher incidence of MACE (HR 4.44, 95% CI: 2.51–7.86; P &lt; 0.001). In patients without ischaemia, the occurrence of MACE was lower in women when compared with men (P &lt; 0.01). Conclusion  Stress CMR is safe and has discriminative prognostic value in elderly, with a significantly lower event rate of future cardiovascular event or death in subjects without ischaemia or infarction.

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