Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease: A Large Retrospective Registry |
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Institution: | 1. Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain;2. Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain;3. Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain;4. Cardiovascular Magnetic Resonance Unit, Exploraciones Radiologicas Especiales (ERESA), Valencia, Spain;5. Department of Cardiology, Hospital Francesc de Borja, Gandia, Spain;6. Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain;7. Department of Cardiology, Hospital General Universitario, Castellón de la Plana, Spain;8. Universitat Jaume I, Castellón de la Plana, Spain;9. Department of Cardiology, Hospital Universitario La Plana, Vila-real, Spain;10. Department of Cardiology, Hospital of Manises, Manises, Spain;11. Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain |
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Abstract: | ObjectivesThis study explored the association of ischemic burden, as measured by vasodilator stress cardiovascular magnetic resonance (CMR), with all-cause mortality and the effect of revascularization on all-cause mortality in patients with stable ischemic heart disease (SIHD).BackgroundIn patients with SIHD, the association of ischemic burden, derived from vasodilator stress CMR, with all-cause mortality and its role for decision-making is unclear.MethodsThe registry consisted of 6,389 consecutive patients (mean age: 65 ± 12 years; 38% women) who underwent vasodilator stress CMR for known or suspected SIHD. The ischemic burden (at stress first-pass perfusion imaging) was computed (17-segment model). The effect of CMR-related revascularization (within the following 3 months) on all-cause mortality was retrospectively explored using the electronic regional health system registry.ResultsDuring a 5.75-year median follow-up, 717 (11%) deaths were documented. In multivariable analyses, more extensive ischemic burden (per 1-segment increase) was independently related to all-cause mortality (hazard ratio: 1.04; 95% confidence interval: 1.02 to 1.07; p < 0.001). In 1,032 1:1 matched patients using a limited number of variables (516 revascularized, 516 non-revascularized), revascularization within the following 3 months was associated with less all-cause mortality only in patients with extensive CMR-related ischemia (>5 segments, n = 432; 10% vs. 24%; p = 0.01).ConclusionsIn a large retrospective registry of unselected patients with known or suspected SIHD who underwent vasodilator stress CMR, extensive ischemic burden was related to a higher risk of long-term, all-cause mortality. Revascularization was associated with a protective effect only in the restricted subset of patients with extensive CMR-related ischemia. Further research will be needed to confirm this hypothesis-generating finding. |
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Keywords: | all-cause mortality cardiovascular magnetic resonance ischemic burden ischemic heart disease prognosis revascularization CABG"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"coronary artery bypass grafting CI"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"confidence interval CMR"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"cardiovascular magnetic resonance DM"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"diabetes mellitus HR"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"hazard ratio LGE"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"late gadolinium enhancement LV"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"left ventricular LVEF"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"left ventricular ejection fraction PCI"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"percutaneous coronary intervention PD"} {"#name":"keyword" "$":{"id":"kwrd0135"} "$$":[{"#name":"text" "_":"perfusion deficit SIHD"} {"#name":"keyword" "$":{"id":"kwrd0145"} "$$":[{"#name":"text" "_":"stable ischemic heart disease |
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