Key result
Vasodilator stress CMR-induced myocardial ischemia independently predicted a higher risk of major adverse cardiovascular events in asymptomatic patients with known obstructive coronary artery disease.
Why the study?
The prognostic value of vasodilator stress CMR had not been formally evaluated specifically in asymptomatic patients with known CAD.
Does vasodilator stress CMR predict major adverse cardiovascular events in asymptomatic patients with obstructive CAD?
Cohort (n=1,342)
No
Does vasodilator stress CMR predict major adverse cardiovascular events in asymptomatic patients with obstructive CAD?
Vasodilator stress CMR-induced myocardial ischemia and LGE are strong, independent long-term predictors of MACE in asymptomatic patients with obstructive CAD, improving risk stratification.
Answers are grounded in this paper and cite their sources.
Stress CMR ischemia and LGE predict MACE in asymptomatic CAD; supports risk stratification but leaves open therapeutic impact.
Several studies have established the prognostic value of vasodilator stress cardiovascular magnetic resonance (CMR) in broad population of patients with suspected or known coronary artery disease (CAD), but this specific population of asymptomatic patients with known CAD have never been formally evaluated. To assess the long-term prognostic value of vasodilator stress perfusion CMR in asymptomatic patients with obstructive CAD. Between 2009 and 2011, consecutive asymptomatic patients with obstructive CAD referred for vasodilator stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (MI). Uni- and multivariable Cox regressions were performed to determine the prognostic value of myocardial ischemia and myocardial infarction defined by late gadolinium enhancement (LGE) with ischemic pattern. Among 1529 asymptomatic patients with obstructive CAD, 1342 (87.8%; 67.7 ± 10.5 years, 82.0% males) completed the follow-up (median 8.3 years), and 195 had MACE (14.5%). Patients without stress-induced myocardial ischemia had a low annualized rate of MACE (2.4%), whereas the annualized rate of MACE was higher for patients with mild, moderate, or severe ischemia (7.3%, 16.8%, and 42.2%, respectively; p trend < 0.001). Using Kaplan–Meier analysis, myocardial ischemia and LGE were associated with MACE (hazard ratio, HR 2.52; 95% CI 1.90–3.34 and HR 2.04; 95% CI 1.38–3.03, respectively; both p < 0.001). In multivariable stepwise Cox regression, myocardial ischemia and LGE were independent predictors of MACE (HR 2.80 95% CI 2.10–3.73, p < 0.001 and HR 1.51; 95% CI 1.01–2.27, p = 0.045; respectively). The addition of myocardial ischemia and LGE led to improved model discrimination for MACE (change in C statistic from 0.61 to 0.68; NRI = 0.207; IDI = 0.021). Vasodilator stress CMR-induced myocardial ischemia and LGE are good long-term predictors for the incidence of MACE in asymptomatic patients with obstructive CAD.
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Pezel et al. (2021) conducted a cohort in Asymptomatic known obstructive coronary artery disease (n=1,342). Vasodilator stress CMR-induced myocardial ischemia vs. Absence of stress-induced myocardial ischemia was evaluated on Major adverse cardiovascular events (MACE) (HR 2.80, 95% CI 2.10-3.73, p=<0.001). Vasodilator stress CMR-induced myocardial ischemia independently predicted a higher risk of major adverse cardiovascular events in asymptomatic patients with known obstructive coronary artery disease.
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