Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease A Large Retrospective Registry
Por:
Marcos-Garces, V, Gavara, J, Monmeneu, J, Lopez-Lereu, M, Bosch, M, Merlos, P, Perez, N, Rios-Navarro, C, De Dios, E, Bonanad, C, Racugno, P, Navarro, A, Perez, B, Botella, J, Ventura, S, Mainar, L, Canoves, J, Pellicer, M, Moratal, D, Minana, G, Nunez, J, Chorro, F and Bodi, V
Publicada:
1 ago 2020
Resumen:
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.
Filiaciones:
Marcos-Garces, V:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Gavara, J:
Inst Invest Sanitaria INCLIVA, Valencia, Spain
Univ Politecn Valencia, Ctr Biomat & Tissue Engn, Valencia, Spain
Monmeneu, J:
Exploraciones Radiol Especi ERESA, Cardiovasc Magnet Resonance Unit, Valencia, Spain
Lopez-Lereu, M:
Exploraciones Radiol Especi ERESA, Cardiovasc Magnet Resonance Unit, Valencia, Spain
:
Hosp Francesc de Borja, Dept Cardiol, Gandia, Spain
:
Hosp Francesc de Borja, Dept Cardiol, Gandia, Spain
Perez, N:
Inst Invest Sanitaria INCLIVA, Valencia, Spain
Rios-Navarro, C:
Inst Invest Sanitaria INCLIVA, Valencia, Spain
De Dios, E:
Ctr Invest Biomed Red Cardiovasc CIBER CV, Madrid, Spain
Bonanad, C:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Inst Invest Sanitaria INCLIVA, Valencia, Spain
Racugno, P:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Inst Invest Sanitaria INCLIVA, Valencia, Spain
:
Hosp Gen Univ, Dept Cardiol, Castellon De La Plana, Spain
Univ Jaume 1, Castellon de La Plana, Spain
Perez, B:
Hosp Gen Univ, Dept Cardiol, Castellon De La Plana, Spain
:
Hosp Univ La Plana, Dept Cardiol, Vila Real, Spain
Mainar, L:
Hosp Manises, Dept Cardiol, Manises, Spain
Canoves, J:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Pellicer, M:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Moratal, D:
Univ Politecn Valencia, Ctr Biomat & Tissue Engn, Valencia, Spain
Minana, G:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Inst Invest Sanitaria INCLIVA, Valencia, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Madrid, Spain
Univ Valencia, Dept Med, Fac Med & Odontol, Valencia, Spain
Nunez, J:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Inst Invest Sanitaria INCLIVA, Valencia, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Madrid, Spain
Univ Valencia, Dept Med, Fac Med & Odontol, Valencia, Spain
Chorro, F:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Inst Invest Sanitaria INCLIVA, Valencia, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Madrid, Spain
Univ Valencia, Dept Med, Fac Med & Odontol, Valencia, Spain
Bodi, V:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
Inst Invest Sanitaria INCLIVA, Valencia, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Madrid, Spain
Univ Valencia, Dept Med, Fac Med & Odontol, Valencia, Spain
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