Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) Study
Key result
CMR perfusion reserve links to adverse outcomes in asymptomatic AS but is not superior to exercise testing.
- AUC 0.61
- 95% CI 0.52-0.71
- P=0.020
- n=174
Why the study?
To assess CMR-measured myocardial perfusion reserve and exercise testing for predicting outcomes in asymptomatic patients with moderate-severe AS.
Does CMR measured myocardial perfusion reserve (MPR) predict outcomes better than exercise testing in asymptomatic patients with moderate-severe aortic stenosis?
Population
174 asymptomatic patients with moderate-severe AS
Comparison
CMR measured myocardial perfusion reserve vs symptom-limited exercise testing
Design
Multi-centre, prospective observational study with blinded analysis of CMR data
Follow-up
Median 374 (IQR 351-498) days
Authors
Discussion
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Member takes
Implication
CMR-measured myocardial perfusion reserve provides moderate prognostic accuracy in asymptomatic aortic stenosis but is not superior to standard symptom-limited exercise testing.
Key Points
- To evaluate myocardial perfusion reserve via CMR and exercise testing in asymptomatic patients with moderate-severe aortic stenosis.
- Multi-centre, prospective, observational study with blinded CMR analysis.
- Participants underwent adenosine stress CMR, symptom-limited exercise testing, and echocardiography. Follow-up lasted 12-30 months for outcomes.
- Primary outcome occurred in 47 (27%) patients over a median 374 days follow-up.
- Mean myocardial perfusion reserve was 2.06 in primary outcome patients versus 2.34 in others (P=0.022).
- Exercise testing demonstrated 45.7% incidence in primary outcome patients versus 27.0% in others (P=0.020).
Study Design
Type
Observational (n=174)
Blinding
Blinded analysis
Multicenter
Yes
Structured PICO
Does CMR measured myocardial perfusion reserve (MPR) predict outcomes better than exercise testing in asymptomatic patients with moderate-severe aortic stenosis?
P
Population
174 asymptomatic patients with moderate-severe aortic stenosis followed for a median of 374 days.
E
Exposure
Cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) using adenosine stress
C
Comparator
Symptom-limited exercise testing (ETT)
O
Outcome
Composite of typical AS symptoms necessitating referral for AVR, cardiovascular death and major adverse cardiovascular eventscomposite
Main Result
Effect estimate: AUC 0.61 (95% CI 0.52-0.71)
p-value: p=0.020
CMR-measured myocardial perfusion reserve provides moderate prognostic accuracy in asymptomatic aortic stenosis but is not superior to standard symptom-limited exercise testing.
Cite This Study
Singh et al. (2017) conducted an observational in Asymptomatic moderate-severe aortic stenosis (n=174). CMR measured myocardial perfusion reserve (MPR) vs. Symptom-limited exercise testing (ETT) was evaluated on Composite of typical AS symptoms necessitating referral for AVR, cardiovascular death and major adverse cardiovascular events (AUC 0.61, 95% CI 0.52-0.71, p=0.020). CMR-measured myocardial perfusion reserve was associated with adverse outcomes in asymptomatic aortic stenosis (AUC 0.61; 95% CI 0.52-0.71) but was not superior to symptom-limited exercise testing.