1. Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease A Large Retrospective Registry
- Author
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Marcos-Garces V, Gavara J, Monmeneu JV, Lopez-Lereu MP, Bosch MJ, Merlos P, Perez N, Rios-Navarro C, De Dios E, Bonanad C, Racugno P, Bellver Navarro A, Ventura Perez B, Aguilar Botella J, Ventura S, Mainar L, Canoves J, Pellicer M, Moratal D, Miñana G, Nuñez J, Chorro FJ, and Bodi V
- Subjects
Male ,ischemic burden ,Magnetic Resonance Spectroscopy ,Vasodilator Agents ,Myocardial Ischemia ,Magnetic Resonance Imaging, Cine ,Middle Aged ,ischemic heart disease ,all-cause mortality, cardiovascular magnetic resonance, ischemic burden, ischemic heart disease, prognosis, revascularization ,cardiovascular magnetic resonance ,Predictive Value of Tests ,Risk Factors ,Humans ,all-cause mortality ,Female ,revascularization ,Registries ,prognosis ,Aged ,Retrospective Studies - 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 < 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). 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. (C) 2020 by the American College of Cardiology Foundation.
- Published
- 2020