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Published on: January 28, 2020
Additional prognostic value of stress cardiovascular magnetic resonance for cardiovascular risk stratification after
Solenn Toupin1, Théo Pezel2,3, Francesca Sanguineti2
1Siemens Healthcare France, Saint-Denis, France.
Insights
Stress cardiovascular magnetic resonance (CMR) effectively predicts major adverse cardiovascular events (MACE) in cryptogenic stroke survivors. This imaging technique offers significant prognostic value beyond traditional risk factors, aiding in better risk stratification.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cryptogenic stroke accounts for one-third of ischemic strokes, with unclear causes.
- Coronary artery disease (CAD) is a leading cause of death post-stroke, yet its screening in cryptogenic stroke patients remains debated.
Purpose of the Study:
- To evaluate the added prognostic capability of stress cardiovascular magnetic resonance (CMR) in predicting cardiovascular events.
- To assess if stress CMR improves risk prediction beyond established factors in patients with prior cryptogenic ischemic stroke.
Main Methods:
- A cohort of 542 patients with prior cryptogenic strokes underwent stress CMR between 2008 and 2021.
- Major adverse cardiovascular events (MACE), including cardiovascular death and myocardial infarction (MI), were tracked.
- Univariable and multivariable Cox regression analyses identified predictors of MACE, focusing on silent ischemia and unrecognized MI.
Main Results:
- Over a median follow-up of 5.9 years, 12.2% of patients experienced MACE.
- Silent ischemia (18%) and unrecognized MI (17%) were significantly associated with MACE (HR > 7.8, p < 0.001).
- Stress CMR findings significantly improved model discrimination and reclassification of MACE risk (C-statistic improvement: 0.13).
Conclusions:
- Stress CMR provides incremental prognostic value for predicting MACE in patients with prior cryptogenic stroke.
- Incorporating stress CMR findings enhances cardiovascular risk assessment beyond traditional factors.
Background:
One-third of ischemic strokes are "cryptogenic" without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest in CAD screening in patients with cryptogenic stroke is still debated.
Aim:
The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.
Materials And Methods:
Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACEs), defined by cardiovascular death or non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.
Results:
Of 542 patients (55.2% male, mean age 71.4 ± 8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18 and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE [hazard ratio, HR: 8.43 (95% CI: 5.11-13.9); HR: 7.87 (95% CI: 4.80-12.9), respectively, p < 0.001]. In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE [HR: 8.08 (95% CI: 4.21-15.5); HR: 6.65 (95% CI: 3.49-12.7), respectively, p < 0.001]. After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI = 0.428; IDI = 0.048).
Conclusion:
In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.
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