1. Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease
- Author
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Jose Aguilar Botella, Jose V. Monmeneu, Vicente Bodi, David Moratal, Elena de Dios, Joaquim Cànoves, Maria P. Lopez-Lereu, Alejandro Bellver Navarro, Bruno Ventura Perez, Luis Mainar, Cesar Rios-Navarro, Víctor Marcos-Garcés, Nerea Perez, Mauricio Pellicer, Paolo Racugno, Clara Bonanad, Gema Miñana, María J. Bosch, Pilar Merlos, Francisco J. Chorro, Silvia Ventura, Julio Núñez, and Jose Gavara
- Subjects
medicine.medical_specialty ,Vasodilator stress ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Ischemia ,Magnetic resonance imaging ,Perfusion scanning ,Disease ,030204 cardiovascular system & hematology ,Revascularization ,medicine.disease ,Confidence interval ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This 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). Background In 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. Methods The 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. Results During 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 5 segments, n = 432; 10% vs. 24%; p = 0.01). Conclusions In 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.
- Published
- 2020