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17.06.2021 | Cardiac

Prognostic value of stress cardiovascular magnetic resonance in asymptomatic patients without known coronary artery disease

verfasst von: Théo Pezel, Philippe Garot, Marine Kinnel, Thierry Unterseeh, Thomas Hovasse, Stéphane Champagne, Solenn Toupin, Francesca Sanguineti, Jérôme Garot

Erschienen in: European Radiology | Ausgabe 8/2021

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Abstract

Objectives

A few studies suggest a significant prognostic value of silent myocardial ischaemia detected in asymptomatic patients. However, the current guidelines do not recommend stress testing in asymptomatic individuals. To assess the long-term prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in asymptomatic individuals without known coronary artery disease (CAD).

Methods

Between 2009 and 2011, a retrospective cohort study with a median follow-up of 9.2 years (interquartile range: 7.8–9.6) included 1,027 consecutive asymptomatic individuals with ≥ 2 cardiovascular risk factors but without known known CAD referred for stress CMR. Major adverse cardiovascular events (MACE) included cardiovascular mortality and nonfatal myocardial infarction (MI).

Results

Among 1,027 asymptomatic subjects, 903 (87.9%) (mean age 70.6 ± 12.4 years and 46.2% males) completed the follow-up, and 91 had MACE (10.1%). Using Kaplan-Meier analysis, silent ischaemia and unrecognised MI were associated with MACE (hazard ratio [HR]: 8.70; 95% CI: 5.79–13.10 and HR: 3.40; 95% CI: 2.15–5.38, respectively; both p < 0.001). In multivariable stepwise Cox regression, silent ischaemia and unrecognised MI were independent predictors of MACE (HR: 6.66; 95% CI 4.41–9.23; and HR: 2.42; 95% CI 1.23–3.21, respectively; both p < 0.001). The addition of silent ischaemia and unrecognised MI led to improved model discrimination for MACE (change in C statistic from 0.66 to 0.82; NRI = 0.497; IDI = 0.070).

Conclusions

Silent ischaemia and unrecognised MI are good long-term predictors for the incidence of MACE in selected asymptomatic individuals with multiple risk factors and without known CAD. These stress CMR parameters have incremental long-term prognostic value to predict MACE over traditional risk factors.

Key Points

• Silent ischaemia and unrecognised myocardial infarction defined by stress CMR are good long-term predictors of cardiovascular events in asymptomatic individuals without known coronary artery disease.

• The addition of stress cardiac MR imaging led to improved model discrimination for cardiovascular events over traditional risk factors in this specific population.

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Benjamin EJ, Muntner P, Alonso A et al (2019) Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation 139:e56–e528. https://doi.org/10.1161/CIR.0000000000000659CrossRefPubMed

Heitner JF, Kim RJ, Kim HW et al (2019) Prognostic value of vasodilator stress cardiac magnetic resonance imaging: a multicenter study with 48 000 patient-years of follow-up. JAMA Cardiol 4:256–264. https://doi.org/10.1001/jamacardio.2019.0035CrossRefPubMedPubMedCentral

Kwong RY, Ge Y, Steel K et al (2019) Cardiac magnetic resonance stress perfusion imaging for evaluation of patients with chest pain. J Am Coll Cardiol 74:1741–1755. https://doi.org/10.1016/j.jacc.2019.07.074CrossRefPubMedPubMedCentral

Ge Y, Pandya A, Steel K et al (2020) Cost-effectiveness analysis of stress cardiovascular magnetic resonance imaging for stable chest pain syndromes. JACC Cardiovasc Imaging 13:1505–1517. https://doi.org/10.1016/j.jcmg.2020.02.029CrossRefPubMed

Antiochos P, Ge Y, Steel K et al (2020) Evaluation of stress cardiac magnetic resonance imaging in risk reclassification of patients with suspected coronary artery disease. JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.2834

Stacey RB, Vera T, Morgan TM et al (2018) Asymptomatic myocardial ischemia forecasts adverse events in cardiovascular magnetic resonance dobutamine stress testing of high-risk middle-aged and elderly individuals. J Cardiovasc Magn Reson 20. https://doi.org/10.1186/s12968-018-0492-5

Sajadieh A, Nielsen OW, Rasmussen V, Hein HO, Hansen JF (2005) Prevalence and prognostic significance of daily-life silent myocardial ischaemia in middle-aged and elderly subjects with no apparent heart disease. Eur Heart J 26:1402–1409. https://doi.org/10.1093/eurheartj/ehi169

Knuuti J, Wijns W, Saraste A et al (2019) 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz425

Patel MR, Bailey SR, Bonow RO et al (2012) ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 59:1995–2027. https://doi.org/10.1016/j.jacc.2012.03.003CrossRefPubMed

10.

Wolk MJ, Bailey SR, Doherty JU et al (2014) ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 63:380–406. https://doi.org/10.1016/j.jacc.2013.11.009CrossRefPubMed

11.

Authors/Task Force Members, Rydén L, Grant PJ et al (2013) ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 34:3035–3087. https://doi.org/10.1093/eurheartj/eht108CrossRef

12.

Bonou M, Benroubis A, Kranidis A et al (2001) Functional and prognostic significance of silent ischemia during dobutamine stress echocardiography in the elderly. Coron Artery Dis 12:499–506. https://doi.org/10.1097/00019501-200109000-00009CrossRefPubMed

13.

Biagini E, Schinkel AFL, Bax JJ et al (2005) Long term outcome in patients with silent versus symptomatic ischaemia during dobutamine stress echocardiography. Heart 91:737–742. https://doi.org/10.1136/hrt.2004.041087CrossRefPubMedPubMedCentral

14.

He ZX, Hedrick TD, Pratt CM et al (2000) Severity of coronary artery calcification by electron beam computed tomography predicts silent myocardial ischemia. Circulation 101:244–251. https://doi.org/10.1161/01.cir.101.3.244CrossRefPubMed

15.

Zellweger MJ, Haaf P, Maraun M et al (2017) Predictors and prognostic impact of silent coronary artery disease in asymptomatic high-risk patients with diabetes mellitus. Int J Cardiol 244:37–42. https://doi.org/10.1016/j.ijcard.2017.05.069CrossRefPubMed

16.

Ng M-Y, Zhou W, Vardhanabhuti V et al (2020) Cardiac magnetic resonance for asymptomatic patients with type 2 diabetes and cardiovascular high risk (CATCH): a pilot study. Cardiovasc Diabetol 19:42. https://doi.org/10.1186/s12933-020-01019-2CrossRefPubMedPubMedCentral

17.

Knuuti J, Ballo H, Juarez-Orozco LE et al (2018) The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J 39:3322–3330. https://doi.org/10.1093/eurheartj/ehy267CrossRefPubMed

18.

Vincenti G, Masci PG, Monney P et al (2017) Stress perfusion CMR in patients with known and suspected CAD. JACC Cardiovasc Imaging 10:526–537. https://doi.org/10.1016/j.jcmg.2017.02.006CrossRefPubMed

19.

Coelho-Filho OR, Seabra LF, Mongeon F-P et al (2011) Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient’s sex. JACC Cardiovasc Imaging 4:850–861. https://doi.org/10.1016/j.jcmg.2011.04.015CrossRefPubMedPubMedCentral

20.

von Elm E, Altman DG, Egger M et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808. https://doi.org/10.1136/bmj.39335.541782.ADCrossRef

21.

Thygesen K, Alpert JS, Jaffe AS et al (2018) Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 72:2231–2264. https://doi.org/10.1016/j.jacc.2018.08.1038CrossRef

22.

Hicks KA, Tcheng JE, Bozkurt B et al (2015) 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials. J Am Coll Cardiol 66:403–469. https://doi.org/10.1016/j.jacc.2014.12.018CrossRefPubMed

23.

Pezel T, Sanguineti F, Kinnel M et al (2020) Prognostic value of dipyridamole stress perfusion cardiovascular magnetic resonance in elderly patients >75 years with suspected coronary artery disease. Eur Heart J Cardiovasc Imaging. https://doi.org/10.1093/ehjci/jeaa193

24.

Kinnel M, Garot J, Pezel T et al (2020) Prognostic value of vasodilator stress perfusion CMR in morbidly obese patients (BMI ≥40 kg/m2) without known CAD. JACC Cardiovasc Imaging 13:1276–1277. https://doi.org/10.1016/j.jcmg.2019.12.002CrossRefPubMed

25.

Pezel T, Sanguineti F, Kinnel M et al (2020) Safety and prognostic value of vasodilator stress cardiovascular magnetic resonance in patients with heart failure and reduced ejection fraction. Circ Cardiovasc Imaging 13. https://doi.org/10.1161/CIRCIMAGING.120.01059926

26.

Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542CrossRef

27.

Schwitter J, Wacker CM, van Rossum AC et al (2008) MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J 29:480–489. https://doi.org/10.1093/eurheartj/ehm617CrossRefPubMed

28.

Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ (2005) Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J 26:1461–1474. https://doi.org/10.1093/eurheartj/ehi258

29.

Kim RJ, Wu E, Rafael A et al (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453. https://doi.org/10.1056/NEJM200011163432003CrossRefPubMed

30.

Conroy RM, Pyörälä K, Fitzgerald AP et al (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24:987–1003. https://doi.org/10.1016/s0195-668x(03)00114-3CrossRefPubMed

31.

Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97:1837–1847

32.

Antiochos P, Ge Y, Steel K et al (2020) Imaging of clinically unrecognized myocardial fibrosis in patients with suspected coronary artery disease. J Am Coll Cardiol 76:945–957. https://doi.org/10.1016/j.jacc.2020.06.063CrossRefPubMed

33.

Gómez-Revelles S, Rossello X, Díaz-Villanueva J et al (2019) Prognostic value of a new semiquantitative score system for adenosine stress myocardial perfusion by CMR. Eur Radiol 29:2263–2271. https://doi.org/10.1007/s00330-018-5774-7CrossRefPubMed

34.

Greenwood JP, Motwani M, Maredia N et al (2014) Comparison of cardiovascular magnetic resonance and single-photon emission computed tomography in women with suspected coronary artery disease from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) Trial. Circulation 129:1129–1138. https://doi.org/10.1161/CIRCULATIONAHA.112.000071CrossRefPubMed

35.

Yang Z, Fu H, Li H et al (2021) Late gadolinium enhancement is a risk factor for major adverse cardiac events in unrecognised myocardial infarction without apparent symptoms: a meta-analysis. Clin Radiol 76:79.e1–79.e11. https://doi.org/10.1016/j.crad.2020.07.038CrossRef

36.

Gibbons RJ, Abrams J, Chatterjee K et al (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107:149–158. https://doi.org/10.1161/01.cir.0000047041.66447.29CrossRefPubMed

37.

Goff DC, Lloyd-Jones DM, Bennett G et al (2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:S49–S73. https://doi.org/10.1161/01.cir.0000437741.48606.98CrossRefPubMed

38.

Monmeneu Menadas JV, Lopez-Lereu MP, Estornell Erill J, Gonzalez PG, Muñoz BI, Gonzalez AM (2016) Pharmacological stress cardiovascular magnetic resonance: feasibility and safety in a large multicentre prospective registry. Eur Heart J Cardiovasc Imaging 17:308–315. https://doi.org/10.1093/ehjci/jev153

39.

Maron DJ, Hochman JS, Reynolds HR et al (2020) Initial invasive or conservative strategy for stable coronary disease. N Engl J Med 382:1395–1407. https://doi.org/10.1056/NEJMoa1915922CrossRefPubMedPubMedCentral

40.

Gada H, Kirtane AJ, Kereiakes DJ et al (2015) Meta-analysis of trials on mortality after percutaneous coronary intervention compared with medical therapy in patients with stable coronary heart disease and objective evidence of myocardial ischemia. Am J Cardiol 115:1194–1199. https://doi.org/10.1016/j.amjcard.2015.01.556CrossRefPubMed

41.

Czarnecki A, Qiu F, Elbaz-Greener G et al (2019) Variation in revascularization practice and outcomes in asymptomatic stable ischemic heart disease. JACC Cardiovasc Interv 12:232–241. https://doi.org/10.1016/j.jcin.2018.10.049CrossRefPubMed

42.

Choi KH, Lee JM, Park I et al (2019) Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia. Int J Cardiol 277:47–53. https://doi.org/10.1016/j.ijcard.2018.08.006CrossRefPubMed

43.

Nagel E, Greenwood JP, McCann GP et al (2019) Magnetic resonance perfusion or fractional flow reserve in coronary disease. N Engl J Med 380:2418–2428. https://doi.org/10.1056/NEJMoa1716734CrossRefPubMed

44.

Nagel E, Chandrashekhar Y (2020) Stress-Only CMR. JACC Cardiovasc Imaging 13:1296–1298. https://doi.org/10.1016/j.jcmg.2020.04.001CrossRefPubMedPubMedCentral

45.

Pontone G, Andreini D, Bertella E et al (2016) Prognostic value of dipyridamole stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a mid-term follow-up study. Eur Radiol 26:2155–2165. https://doi.org/10.1007/s00330-015-4064-xCrossRefPubMed

Titel: Prognostic value of stress cardiovascular magnetic resonance in asymptomatic patients without known coronary artery disease
verfasst von: Théo Pezel
Philippe Garot
Marine Kinnel
Thierry Unterseeh
Thomas Hovasse
Stéphane Champagne
Solenn Toupin
Francesca Sanguineti
Jérôme Garot
Publikationsdatum: 17.06.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 8/2021
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-08078-3

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Prognostic value of stress cardiovascular magnetic resonance in asymptomatic patients without known coronary artery disease