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Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease: A Large Retrospective Registry
Victor Marcos-Garces1, Jose Gavara2, Jose V Monmeneu3
1Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain.
Insights
Extensive ischemic burden measured by vasodilator stress cardiovascular magnetic resonance (CMR) is linked to higher mortality in stable ischemic heart disease (SIHD). Revascularization benefits only patients with significant ischemia.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Stable ischemic heart disease (SIHD) patient outcomes are influenced by ischemic burden.
- The prognostic value of vasodilator stress cardiovascular magnetic resonance (CMR) for all-cause mortality in SIHD is not fully understood.
- The impact of revascularization on mortality based on ischemic burden requires further investigation.
Purpose of the Study:
- To explore the association between ischemic burden, assessed by vasodilator stress CMR, and all-cause mortality in SIHD patients.
- To evaluate the effect of revascularization on all-cause mortality in SIHD patients, considering the extent of ischemia.
Main Methods:
- A retrospective analysis of 6,389 patients with known or suspected SIHD who underwent vasodilator stress CMR.
- Ischemic burden was quantified using a 17-segment model based on stress first-pass perfusion imaging.
- Revascularization's impact on all-cause mortality was assessed in matched cohorts within 3 months of CMR.
Main Results:
- Increased ischemic burden (per segment) was independently associated with higher all-cause mortality (HR 1.04; p < 0.001).
- Over a median follow-up of 5.75 years, 11% of patients died.
- Revascularization reduced mortality only in patients with extensive ischemia (>5 segments) (10% vs. 24%; p = 0.01).
Conclusions:
- Extensive ischemic burden identified by vasodilator stress CMR predicts increased long-term all-cause mortality in SIHD.
- Revascularization demonstrates a protective effect on mortality, but primarily in a select group of patients with significant ischemia.
- These findings suggest a tailored approach to revascularization based on CMR-derived ischemic burden may be beneficial.
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.
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