Key result
Elevated aortic pulse wave velocity combined with positive late gadolinium enhancement was associated with a significantly higher rate of MACE (HR 11.90, p < 0.001).
Why the study?
Prognostic data combining aortic stiffness and myocardial scarring from late gadolinium enhancement CMR remained limited.
Does elevated aortic stiffness combined with late gadolinium enhancement predict major adverse cardiovascular events in patients undergoing clinical CMR?
Cohort (n=402)
Does elevated aortic stiffness combined with late gadolinium enhancement predict major adverse cardiovascular events in patients undergoing clinical CMR?
Hazard Ratio: 11.9
p-value: p=< 0.001
Aortic stiffness measured by VE-CMR combined with LGE provides significant prognostic value for predicting major adverse cardiovascular events.
Identifies high-MACE-risk patients for closer surveillance; extends evidence for combined PWV-LGE risk stratification in cardiac evaluation.
BACKGROUND: Increased aortic stiffness has been established as a marker in various cardiovascular diseases. Previous reports revealed a significant correlation between aortic stiffness and myocardial scarring using the late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR). However, prognostic data concerning aortic stiffness combining myocardial scarring remains limited. METHOD: A total of 402 patients who had undergone clinical CMR for the evaluation of cardiac function, LGE, and aortic pulse wave velocity (PWV) using velocity encoded-CMR (VE-CMR) were included. Patients were classified into 4 groups using mean PWV and the presence of LGE as elevated or non-elevated PWV and positive or negative LGE. Patients received follow-up for major adverse cardiovascular events (MACE) comprising cardiovascular death, non-fatal myocardial infarction, hospitalization for heart failure, coronary revascularization, and ischemic stroke. Predictors of MACE and hard cardiac events (cardiovascular death or non-fatal myocardial infarction) were evaluated. RESULTS: During the average follow-up period of 47.7 months, 58 MACE occurred. Patients who had elevated PWV and positive LGE experienced the highest rate of MACE compared to the group with non-elevated PWV and negative LGE (HR 11.90, p < 0.001). Among patients who had LGE, those who had elevated PWV experienced a 2.4-times higher rate of MACE compared to those who had non-elevated PWV. Multivariate analysis showed that PWV and LGE were independent predictors of MACE and hard cardiac events. PWV had excellent intra- and inter-observer reproducibility (intra-: ICC = 0.98, p < 0.001, inter-: ICC = 0.97, p < 0.001). CONCLUSION: Aortic stiffness using VE-CMR had prognostic value to predict cardiovascular events, with the added benefits of LGE.
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Kaolawanich et al. (2020) conducted a cohort in Patients undergoing clinical cardiovascular magnetic resonance (n=402). Elevated aortic pulse wave velocity (PWV) and positive late gadolinium enhancement (LGE) vs. Non-elevated PWV and negative LGE was evaluated on Major adverse cardiovascular events (MACE) comprising cardiovascular death, non-fatal myocardial infarction, hospitalization for heart failure, coronary revascularization, and ischemic stroke (HR 11.90, p=< 0.001). Elevated aortic pulse wave velocity combined with positive late gadolinium enhancement was associated with a significantly higher rate of MACE (HR 11.90, p < 0.001).
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