Vasodilator stress CMR independently predicts all-cause death in diabetics, with ischemia extent HR 1.13 per segment and unrecognized MI HR 1.14; revascularization reduced death HR 0.28.
Does the presence and extent of inducible ischaemia and unrecognised myocardial infarction on vasodilator stress perfusion CMR predict all-cause death in diabetic patients?
Vasodilator stress perfusion CMR provides independent and incremental prognostic value for predicting all-cause death in diabetic patients beyond traditional risk factors.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background The benefit of screening for coronary artery disease (CAD) in diabetic patients and the adequate stress-test to use are not well established. Although stress cardiovascular magnetic resonance (CMR) has a good prognostic value in large cohorts of patients, its prognostic value in a dedicated cohort of diabetic patients has not been evaluated. Purpose The aim of this study was to assess the long-term prognostic value of vasodilator stress perfusion CMR in diabetic patients. Methods Between December 2008 and January 2022, we conducted a multicentre longitudinal study with consecutive diabetic patients, referred for vasodilator stress perfusion CMR to 3 hospitals. The primary outcome was all-cause death defined by the National Death Registry. Univariable and multivariable Cox regressions for all-cause death were performed to determine the prognostic value of inducible ischaemia and unrecognised myocardial infarction (MI) by CMR. Results Among 13,911 patients (mean age 64.3± 12 years; 69.5% males) with a median follow up of 7.3 years, 1,429 (10.3%) died. Patients without inducible ischaemia experienced a lower rate of all-cause death than those with an inducible ischaemia (9.4 versus 15.0%, respectively, p0.001). In univariate analysis, the extent of inducible ischaemia and unrecognised MI were significantly associated with the occurrence of all-cause death (hazard ratio HR per segment: 1.17; 99.5% confidence interval CI: 1.13-1.21 and HR: 1.25, 99.5%CI: 1.20-1.29, respectively; both p0.001). In multivariable analysis, the extent of inducible ischaemia and unrecognised MI were independent predictors of a higher incidence of all-cause death (HR per segment: 1.13, 99.5% CI: 1.09-1.18, and HR: 1.14, 99.5%CI: 1.09-1.19 respectively, both p0.001). These findings were consistent in all subgroups, including in patients with or without a known CAD; and in both symptomatic and asymptomatic patients. In patients with ischaemia, CMR-guided coronary revascularisation was associated with a lower rate of all-cause death (HR: 0.28, 99.5%CI: 0.20-0.39, p0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional prognostic factors (C-statistic improvement:0.01; net reclassification improvement: 0.185; integrative discrimination index: 0.046; both p0.001). Conclusions In patients with diabetes mellitus, vasodilator stress CMR has independent and incremental prognostic value to predict all-cause death over traditional prognostic factors.
Houssany-Pissot et al. (Sat,) reported a other. Vasodilator stress CMR independently predicts all-cause death in diabetics, with ischemia extent HR 1.13 per segment and unrecognized MI HR 1.14; revascularization reduced death HR 0.28.