Long-Term Prognostic Value of Stress Cardiovascular Magnetic Resonance–Related Coronary Revascularization to Predict Death: A Large Registry With >200 000 Patient-Years of Follow-Up

2021 ◽  
Author(s):  
Théo Pezel ◽  
Thierry Unterseeh ◽  
Philippe Garot ◽  
Thomas Hovasse ◽  
Francesca Sanguineti ◽  
...  
Keyword(s):  
Lower Incidence ◽  
Prognostic Value ◽  
Coronary Revascularization ◽  
Hazard Ratio ◽  
Gadolinium Enhancement ◽  
Inducible Ischemia ◽  
Stress Cmr ◽  
Stress Cardiovascular Magnetic Resonance

Background: Although the benefit of coronary revascularization in patients with stable coronary disease is debated, data assessing the potential interest of stress cardiovascular magnetic resonance (CMR) to guide coronary revascularization are limited. We aimed 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. 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 National Death Registry. Results: Among the 31 762 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2679 (8.4%) died at 206 453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement by CMR were associated with death (both P <0.001). In multivariable Cox regression, inducible ischemia and late gadolinium enhancement were independent predictors of death (hazard ratio, 1.61 [99.5% CI, 1.41–1.84]; hazard ratio, 1.62 [99.5% CI, 1.41–1.86], respectively; P <0.001). In the overall population, CMR-related coronary revascularization was an independent predictor of greater survival (hazard ratio, 0.58 [99.5% CI, 0.46–0.74]; P <0.001). In 1680, 1:1 matched patients using a limited number of variables (840 revascularized, 840 nonrevascularized), CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (≥6 segments, P <0.001) but showed no benefit in patients with mild or moderate ischemia (<6 segments, P =0.109). Using multivariable analysis in the propensity-matched population, CMR-related revascularization remained an independent predictor of a lower incidence of all-cause mortality (hazard ratio, 0.66 [99.5% CI, 0.54–0.80], P <0.001). 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 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 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.

P5256Vasodilator stress perfusion CMR is feasible and has prognostic value in morbid obese patients without known CAD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kinnel ◽  
T Pezel ◽  
T Hovasse ◽  
P Garot ◽  
T Unterseeh ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiac Death ◽  
Prognostic Value ◽  
Hazard Ratio ◽  
Stress Perfusion ◽  
Obese Patients ◽  
Inducible Ischemia ◽  
Morbid Obese ◽  
Stress Cmr

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.

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

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.

scholarly journals Long-Term Prognostic Value of Stress Cardiovascular Magnetic Resonance in Patients With History of Percutaneous Coronary Intervention

2021 ◽  
Vol 14 (6) ◽  
Author(s):  
Théo Pezel ◽  
Thomas Hovasse ◽  
Marine Kinnel ◽  
Francesca Sanguineti ◽  
Stéphane Champagne ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Late Gadolinium Enhancement ◽  
Prognostic Value ◽  
Coronary Intervention ◽  
Hazard Ratio ◽  
Gadolinium Enhancement ◽  
Inducible Ischemia ◽  
Percutaneous Coronary ◽  
History Of ◽  
Stress Cmr

Background: Recurrence of cardiovascular events remains a substantial cause of mortality and morbidity among patients with previous coronary revascularization. The aim was to assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters in patients with history of percutaneous coronary intervention. Methods: Between 2011 and 2014, consecutive patients with history of percutaneous coronary intervention referred for stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACEs), defined by cardiovascular death or nonfatal myocardial infarction. Patients with prior coronary artery bypass graft were excluded. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter. Results: Of 1762 patients who completed the CMR protocol, 1624 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); 244 experienced a MACE (15.0%). Stress CMR was well tolerated. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement were significantly associated with the occurrence of MACE (hazard ratio, 2.70 [95% CI, 2.11–3.46], P <0.001; and hazard ratio: 1.52 [95% CI, 1.16–1.99], P =0.002; respectively). In multivariable Cox regression, inducible ischemia and late gadolinium enhancement were independent predictors of a higher incidence of MACE (hazard ratio, 2.79 [95% CI, 2.16–3.60]; P <0.001 and hazard ratio, 1.41 [95% CI, 1.04–1.90], P =0.032; respectively). Conclusions: Inducible ischemia and late gadolinium enhancement assessed by stress CMR were independently associated with MACE in patients with history of percutaneous coronary intervention.

Long-term prognostic value of late gadolinium enhancement and periprocedural myocardial infarction after uncomplicated revascularization: MASS-V follow-up

2020 ◽  
Author(s):  
Jaime Linhares-Filho ◽  
Whady Hueb ◽  
Eduardo Lima ◽  
Paulo Rezende ◽  
Diogo Azevedo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Independent Predictor ◽  
Cardiac Biomarkers ◽  
Gadolinium Enhancement ◽  
Periprocedural Myocardial Infarction ◽  
Lge Cmr

Abstract Aims Cardiac biomarkers elevation is common after revascularization, even in absence of periprocedural myocardial infarction (PMI) detection by imaging methods. Thus, late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may be useful on PMI diagnosis and prognosis. We sought to evaluate long-term prognostic value of PMI and new LGE after revascularization. Methods and results Two hundred and two patients with multivessel coronary disease and preserved ventricular function who underwent elective revascularization were included, of whom 136 (67.3%) underwent coronary artery bypass grafting and 66 (32.7%) percutaneous coronary intervention. The median follow-up was 5 years (4.8–5.8 years). Cardiac biomarkers measurement and LGE-CMR were performed before and after procedures. The Society for Cardiovascular Angiography and Interventions definition was used to assess PMI. Primary endpoint was composed of death, infarction, additional revascularization, or cardiac hospitalization. Primary endpoint was observed in 29 (14.3%) patients, of whom 13 (14.9%) had PMI and 16 (13.9%) did not (P = 0.93). Thirty-six (17.8%) patients had new LGE. Twenty (12.0%) events occurred in patients without new LGE and 9 (25.2%) in patients with it (P = 0.045). LGE was also associated to increased mortality, with 4 (2.4%) and 4 (11.1%) deaths in subjects without and with it (P = 0.02). LGE was the only independent predictor of primary endpoint and mortality (P = 0.03 and P = 0.02). Median LGE mass was estimated at 4.6 g. Patients with new LGE had a greater biomarkers release (median troponin: 8.9 ng/mL vs. 1.8 ng/mL and median creatine kinase-MB: 38.0 ng/mL vs. 12.3 ng/mL; P &lt; 0.001 in both comparisons). Conclusions New LGE was shown to be better prognostic predictor than biomarker-only PMI definition after uncomplicated revascularization. Furthermore, new LGE was the only independent predictor of cardiovascular events and mortality. Clinical trial registration http://www.controlled-trials.com/ISRCTN09454308.

scholarly journals Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in CKD Patients

2019 ◽  
Vol 14 (2) ◽  
pp. 233-240 ◽  
Author(s):  
Francesca Mallamaci ◽  
Giovanni Tripepi ◽  
Graziella D’Arrigo ◽  
Silvio Borrelli ◽  
Carlo Garofalo ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Clinic Visit ◽  
Hazard Ratio ◽  
Interquartile Range ◽  
Short Term ◽  
End Point

Background and objectivesShort-term BP variability (derived from 24-hour ambulatory BP monitoring) and long-term BP variability (from clinic visit to clinic visit) are directly related to risk for cardiovascular events, but these relationships have been scarcely investigated in patients with CKD, and their prognostic value in this population is unknown.Design, setting, participants, & measurementsIn a cohort of 402 patients with CKD, we assessed associations of short- and long-term systolic BP variability with a composite end point of death or cardiovascular event. Variability was defined as the standard deviation of observed BP measurements. We further tested the prognostic value of these parameters for risk discrimination and reclassification.ResultsMean ± SD short-term systolic BP variability was 12.6±3.3 mm Hg, and mean ± SD long-term systolic BP variability was 12.7±5.1 mm Hg. For short-term BP variability, 125 participants experienced the composite end point over a median follow-up of 4.8 years (interquartile range, 2.3–8.6 years). For long-term BP variability, 110 participants experienced the composite end point over a median follow-up of 3.2 years (interquartile range, 1.0–7.5 years). In adjusted analyses, long-term BP variability was significantly associated with the composite end point (hazard ratio, 1.24; 95% confidence interval, 1.01 to 1.51 per 5-mm Hg higher SD of office systolic BP), but short-term systolic BP variability was not (hazard ratio, 0.92; 95% confidence interval, 0.68 to 1.25 per 5-mm Hg higher SD of 24-hour ambulatory systolic BP). Neither estimate of BP variability improved risk discrimination or reclassification compared with a simple risk prediction model.ConclusionsIn patients with CKD, long-term but not short-term systolic BP variability is related to the risk of death and cardiovascular events. However, BP variability has a limited role for prediction in CKD.

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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