Key result
Inducible ischaemia on dipyridamole stress CMR was an independent predictor of major adverse cardiovascular events in elderly patients >75 years (HR 4.44; 95% CI 2.51-7.86; P<0.001).
Why the study?
Data on the prognostic value of stress CMR in elderly people are very limited, despite steadily increasing life expectancy.
Does dipyridamole stress perfusion CMR predict major adverse cardiovascular events in elderly patients >75 years with suspected coronary artery disease?
Cohort (n=754)
Does dipyridamole stress perfusion CMR predict major adverse cardiovascular events in elderly patients >75 years with suspected coronary artery disease?
Dipyridamole stress perfusion CMR provides significant prognostic value in elderly patients >75 years with suspected CAD, with inducible ischemia strongly predicting future MACE.
Stress CMR aids risk stratification in elderly without known CAD; hypothesis-generating before guiding management decisions.
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 >75 years. METHODS AND RESULTS: Between 2008 and 2017, we included consecutive elderly >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 < 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 < 0.001). In patients without ischaemia, the occurrence of MACE was lower in women when compared with men (P < 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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Pezel et al. (2020) conducted a cohort in suspected coronary artery disease (n=754). Inducible myocardial ischaemia on dipyridamole stress CMR vs. Absence of myocardial ischaemia was evaluated on major adverse cardiovascular events (MACE) including cardiac death or non-fatal myocardial infarction (HR 4.44, 95% CI 2.51-7.86, p=< 0.001). Inducible ischaemia on dipyridamole stress CMR was an independent predictor of major adverse cardiovascular events in elderly patients >75 years (HR 4.44; 95% CI 2.51-7.86; P<0.001).
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