Prognostic Value of Adenosine Stress Perfusion Cardiac Magnetic Resonance Imaging in Older Adults with Known or Suspected Coronary Artery Disease

Kaolawanich, Yodying; Boonyasirinant, Thananya

Acessibilidade / Reportar erro

Brasil

Arquivos Brasileiros de Cardiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arq. Bras. Cardiol. 119 (1) • July 2022 • https://doi.org/10.36660/abc.20210530 copy

Prognostic Value of Adenosine Stress Perfusion Cardiac Magnetic Resonance Imaging in Older Adults with Known or Suspected Coronary Artery Disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

There is limited data on the prognostic value of stress cardiac magnetic resonance (CMR) in older adults.

Objective:

To determine the prognostic value of adenosine stress CMR in older individuals with known or suspected coronary artery disease (CAD).

Methods:

Between 2010 and 2015, consecutive patients aged 65 years or older referred for adenosine stress CMR were followed for the occurrence of severe cardiac events (cardiac death and nonfatal myocardial infarction) and major adverse cardiovascular events (MACE) that also included hospitalization for heart failure and ischemic stroke. Univariate and multivariate analyses were performed to determine the prognostic value of myocardial ischemia, with p-value <0.05 considered statistically significant.

Results:

After a mean follow-up period of 50.4 months in 324 patients (48% male, 73±7 years), 21 severe cardiac events and 52 MACE occurred. Patients with myocardial ischemia (n=99) had significantly higher rates of severe cardiac events (HR 5.25 [95% CI 2.11-13.04], p<0.001) and MACE (HR 3.01 [95% CI 1.75-5.20], p<0.001) than those without ischemia. Multivariable analysis determined ischemia as an independent predictor of severe cardiac events (HR 3.14 [95% CI 1.22-8.07], p=0.02) and MACE (HR 1.91 [95%CI 1.02-3.59], p=0.04). Ischemia provided an incremental prognostic value over clinical factors and left ventricular ejection fraction for predicting severe cardiac events and MACE (p<0.01 for both). No severe adverse events occurred during or immediately after CMR examinations.

Conclusion:

Adenosine stress CMR is safe and has prognostic value in older adults with known or suspected CAD.

Keywords:
Adenosine; Cardiac Magnetic Resonance Imaging; Coronary Artery Disease; Elderly; Stress Test

	Total	Ischemia Present	Ischemia Absent	p-value
	(n=324)	(n=99)	(n=225)	p-value
Male gender	156 (48.1)	55 (55.6)	101 (44.9)	0.08
Age, years	72.7 ± 7.4	72.9 ± 7.7	72.6 ± 7.3	0.73
Body mass index, kg/m²	26.5 ± 4.2	25.8 ± 3.9	26.9 ± 4.2	0.03
Systolic blood pressure, mmHg	138.8 ± 18.9	142.2 ± 19.3	137.3 ± 18.7	0.03
Diastolic blood pressure, mmHg	72.8 ± 11.5	71.9 ± 12.1	73.2 ± 11.2	0.33
Heart rate, bpm	76.9 ± 13.1	76.2 ± 12.8	77.2 ± 13.3	0.52
Hypertension	289 (89.2)	87 (87.8)	202 (89.8)	0.61
Diabetes mellitus	188 (58.0)	57 (57.6)	131 (58.2)	0.91
Hyperlipidemia	231 (71.3)	74 (74.8)	157 (69.8)	0.36
Stable coronary artery disease	46 (14.2)	28 (28.3)	18 (8.0)	<0.001
Previous myocardial infarction	6 (1.9)	5 (5.1)	1 (0.4)	0.01
Prior revascularization	14 (4.3)	8 (8.1)	6 (2.7)	0.04
History of typical angina	31 (9.6)	15 (15.2)	16 (7.1)	0.02
History of heart failure	23 (7.1)	9 (9.1)	14 (6.2)	0.35
Stroke	16 (4.9)	4 (4.0)	12 (5.3)	0.78
Current smoking	37 (11.4)	22 (22.2)	15 (6.7)	<0.001
Medications
ACEI or ARB	148 (45.7)	50 (50.5)	98 (43.6)	0.25
Antiplatelet	153 (47.2)	60 (60.6)	93 (41.3)	0.001
Beta-blocker	151 (46.6)	47 (47.5)	104 (46.2)	0.84
Calcium channel blocker	111 (34.3)	35 (35.4)	76 (33.8)	0.78
Nitrate	49 (15.1)	25 (25.3)	24 (10.7)	0.001
Statin	156 (48.2)	51 (51.5)	105 (46.7)	0.42
CMR
Left atrial diameter, mm	32.9 ± 4.0	33.6 ± 4.1	32.6 ± 3.9	0.05
LV mass index, g/m²	51.9 ± 16.8	59.0 ± 18.8	48.9 ± 14.8	<0.001
LVEDV index, ml/m²	74.7 ± 24.4	82.1 ± 29.0	71.5 ± 21.4	<0.001
LVESV index, ml/m²	25.7 ± 22.9	32.2 ± 29.9	22.8 ± 18.3	<0.001
LVEF, %	68.8 ± 13.8	65.1 ± 17.5	70.5 ± 11.5	0.001
Presence of LGE	67 (20.7)	45 (45.5)	22 (9.8)	<0.001
Average numbers of segments with LGE	4.1 ± 2.5	4.3 ± 2.6	3.6 ± 2.4	0.16

	Total	Ischemia Present	Ischemia Absent	HR (95% CI)	p Value
All-cause mortality	18 (5.6)	10 (10.1)	8 (3.6)	3.13 (1.23, 7.94)	0.02
Cardiac mortality	8 (2.5)	6 (6.1)	2 (0.9)	7.59 (1.53, 37.66)	0.01
Nonfatal myocardial infarction	18 (5.6)	12 (12.1)	6 (2.7)	5.22 (1.95, 13.94)	0.001
Hospitalization for heart failure	31 (9.6)	16 (16.2)	15 (6.7)	2.81(1.38, 5.70)	0.004
Ischemic stroke	9 (2.8)	3 (3.0)	6 (2.7)	1.31 (0.32, 5.25)	0.70
Severe cardiac events^a a Five patients had two events (nonfatal myocardial infarction and cardiac mortality).	21 (6.5)	14 (14.1)	7 (3.1)	5.25 (2.11, 13.04)	<0.001
MACE^b b Nine patients had more than one event (six patients had two events, one patient had three events, and two patients had four events). Values represent the number of patients (percentages). Bold values are <0.05. CI: confidence interval; HR: hazard ratio; MACE: major adverse cardiovascular events.	52 (16.0)	27 (27.3)	25 (11.1)	3.01 (1.75, 5.20)	<0.001

	Univariable Analysis		Multivariable Analysis
	Univariable Analysis		Model 1^a a Myocardial ischemia was included as a categorical variable (presence or absence).		Model 2^b b Myocardial ischemia was included as a continuous variable (per-segment extent). Bold values are <0.05. ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CMR: cardiac magnetic resonance; EDV: end diastolic volume; ESV: end systolic volume; EF: ejection fraction; LGE: late gadolinium enhancement; LV: left ventricular.
	HR (95% CI)	P-Value	HR (95% CI)	p Value	HR (95% CI)	p-value
Male gender	1.26 (0.53, 2.97)	0.59
Age, years	1.01 (0.95, 1.07)	0.70
Body mass index, kg/m²	0.90 (0.81, 1.01)	0.08
Systolic blood pressure	0.99 (0.97, 1.02)	0.63
Diastolic blood pressure	0.98 (0.94, 1.02)	0.33
Heart rate, bpm	1.01 (0.97, 1.04)	0.71
Hypertension	2.57 (0.34, 19.17)	0.36
Diabetes mellitus	1.21 (0.51, 2.89)	0.67
Hyperlipidemia	1.06 (0.39, 2.92)	0.90
Stable coronary artery disease	2.26 (0.82, 6.19)	0.11
Previous myocardial infarction	9.36 (2.75, 31.81)	<0.001	6.70 (1.83, 24.49)	0.004	5.90 (1.52, 22.93)	0.01
History of typical angina	2.80 (1.02, 7.65)	0.04
History of heart failure	2.78 (0.93, 8.30)	0.07
Stroke	0.05 (0.00-177.4)	0.46
Current smoking	1.82 (0.61, 5.41)	0.28
ACEI or ARB	1.11 (0.46, 2.60)	0.82
Antiplatelet	2.09 (0.84, 5.20)	0.11
Beta-blocker	1.15 (0.48, 2.71)	0.75
Calcium channel blocker	0.96 (0.38, 2.38)	0.94
Nitrate	3.03 (1.25, 7.33)	0.01
Statin	1.46 (0.61, 3.47)	0.39
Left atrial diameter, mm	1.16 (1.06, 1.27)	0.002
LV mass index, g/m²	1.03 (1.02, 1.05)	<0.001	1.04 (1.02, 1.05)	0.001	1.03 (1.02, 1.05)	0.001
LVEDV index, ml/m²	1.02 (1.01, 1.03)	<0.001
LVESV index, ml/m²	1.02 (1.01, 1.03)	0.001
LVEF, %	0.96 (0.94, 0.99)	0.01
Presence of myocardial ischemia	5.25 (2.11, 13.04)	<0.001	3.14 (1.22, 8.07)	0.02	-	-
Ischemia extent, per 1 segment	1.17 (1.09, 1.26)	<0.001	-	-	1.11 (1.02, 1.20)	0.01
Presence of LGE	4.97 (2.11, 11.73)	<0.001

	Univariable Analysis		Multivariable Analysis
	Univariable Analysis		Model 1^a a Myocardial ischemia was included as a categorical variable (present or absent).		Model 2^b b Myocardial ischemia was included as a continuous variable (per-segment extent). Bold values are <0.05. ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CMR: cardiac magnetic resonance; EDV: end diastolic volume; ESV: end systolic volume; EF: ejection fraction; MACE: major adverse cardiovascular events; LGE: late gadolinium enhancement; LV: left ventricular.
	HR (95% CI)	p Value	HR (95% CI)	p Value	HR (95% CI)	p-value
Male gender	1.15 (0.67, 1.99)	0.61
Age, years	1.05 (1.01, 1.08)	0.02
Body mass index, kg/m²	0.98 (0.92, 1.05)	0.60
Systolic blood pressure	0.99 (0.98, 1.01)	0.43
Diastolic blood pressure	0.97 (0.95, 0.99)	0.02
Heart rate, bpm	1.01 (0.99, 1.03)	0.30
Hypertension	2.11 (0.66, 6.78)	0.21
Diabetes mellitus	1.21 (0.70, 2.11)	0.50
Hyperlipidemia	1.17 (0.61, 2.23)	0.64
Stable coronary artery disease	1.58 (0.77, 3.24)	0.22
Previous myocardial infarction	6.13 (2.21, 17.06)	0.001
History of typical angina	1.43 (0.64, 3.17)	0.38
History of heart failure	3.70 (1.90, 7.20)	<0.001	3.50 (1.79, 6.82)	0.001	3.32 (1.70, 6.50)	0.001
Stroke	1.15 (0.36, 3.70)	0.81
Current smoking	1.62 (0.79, 3.33)	0.19
ACEI or ARB	1.23 (0.71, 2.11)	0.46
Antiplatelet	1.57 (0.90, 2.73)	0.11
Beta blocker	1.02 (0.59, 1.77)	0.93
Calcium channel blocker	0.69 (0.37, 1.27)	0.24
Nitrate	1.87 (1.01, 3.45)	0.04
Statin	1.19 (0.69, 2.05)	0.53
Left atrial diameter, mm	1.13 (1.06, 1.20)	<0.001
LV mass index, g/m²	1.03 (1.02, 1.04)	<0.001
LVEDV index, ml/m²	1.02 (1.01, 1.03)	<0.001
LVESV index, ml/m²	1.02 (1.01, 1.03)	<0.001
LVEF, %	0.97 (0.95, 0.98)	<0.001
Presence of myocardial ischemia	3.01 (1.75, 5.20)	<0.001	1.91 (1.02, 3.59)	0.04	-	-
Ischemia extent, per 1 segment	1.11 (1.06, 1.17)	<0.001	-	-	1.08 (1.01, 1.14)	0.02
Presence of LGE	3.70 (2.13, 6.43)	<0.001	2.64 (1.39, 4.99)	0.003	2.86 (1.58, 5.17)	0.001

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Mailing Address: Thananya Boonyasirinant • Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University. 2 Wanglang Road, Bangkok Noi, Bangkok, Thailand, 10700 E-mail: drthananyaa@yahoo.com