In patients with hypertension without known CAD, the presence of ischaemia on stress CMR was associated with a higher rate of MACE compared to those without ischaemia (39% vs 12%; HR 4.1; p<0.001).
Cohort (n=2,019)
Does vasodilator stress CMR predict major cardiovascular events in patients with hypertension without known coronary artery disease?
Stress CMR provides significant long-term prognostic value for predicting major cardiovascular events in hypertensive patients without known coronary artery disease.
Effect estimate: HR 4.1 (95% CI 3.0-5.7)
Absolute Event Rate: 39% vs 12%
p-value: p=<0.001
AIM: Benefits of screening coronary artery disease (CAD) using stress perfusion cardiovascular magnetic resonance (CMR) in patients with hypertension without known CAD is not well established. The aim of our study was to assess the long-term prognostic value of vasodilator stress CMR in patients with hypertension without known CAD. METHODS: Between December 2008 and January 2022, all consecutive patients with hypertension without known CAD referred for stress CMR were followed up to the occurrence of major cardiovascular events (MACE), defined as cardiovascular mortality or non-fatal myocardial infarction (MI). Cox regressions were performed to determine the prognostic value of each parameter. RESULTS: Among 2,019 patients (69 ± 12 years; 45% male) with a median follow up of 6.7 (5.9- 8.9) years, 327 had MACE (16%). Patients without ischaemia experienced a lower rate of MACE than those with ischaemia (12 versus 39%, respectively, p < 0.001). Ischaemia and unrecognised MI were both significantly associated with the occurrence of MACE (respectively, HR: 4.1, 99.5%CI: 3.0-5.7 and HR: 3.6, 99.5%CI: 2.6-5.1, both p < 0.001). After adjustment, both the extent of ischaemia and unrecognised MI were independent predictors of MACE (respectively, HR: 1.2, 99.5%CI: 1.2-1.3, and HR: 1.2, 99.5%CI: 1.1-1.3, both p < 0.001). Adding stress CMR parameters improved model discrimination and reclassification, with greatest improvements in stepwise Model (C-statistic improvement: 0.02; net reclassification improvement: 0.50; integrative discrimination index: 0.02; all p < 0.001). CONCLUSION: In patients with hypertension without known CAD, stress CMR is a long-term predictor for the incidence of MACE and offer an incremental prognostic value over traditional predictors.
Houssany-Pissot et al. (Sun,) conducted a cohort in Hypertension without known coronary artery disease (n=2,019). Vasodilator stress CMR (presence of ischaemia) vs. Absence of ischaemia was evaluated on Major cardiovascular events (MACE), defined as cardiovascular mortality or non-fatal myocardial infarction (HR 4.1, 95% CI 3.0-5.7, p=<0.001). In patients with hypertension without known CAD, the presence of ischaemia on stress CMR was associated with a higher rate of MACE compared to those without ischaemia (39% vs 12%; HR 4.1; p<0.001).