Interventional MRI - Devices

1348672 - Safety, Feasibility and Prognostic Value of Stress Perfusion CMR in Patients with MR-conditional Pacemaker

Friday, January 27, 2023

12:20 PM – 1:20 PM

Location: Pacific Jewel

Presenting Author(s)

Theo Pezel, MD

Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France

Primary Author(s)

Theo Pezel, MD

Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France

Co-Author(s)

JL

Jérôme Lacotte, MD

Electrophysiologist
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
JH

Jérôme Horvilleur, MD

Electrophysiologist
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
ST

Solenn Toupin, PhD

Clinical scientist
Siemens Healthcare France, Scientific partnerships, Saint-Denis
Bordeaux, Aquitaine, France
TH

Thomas Hovasse, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
TU

Thierry Unterseeh, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
FS

Francesca Sanguineti, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
MA

Mina Ait Said, MD

Electrophysiologist
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
FS

Fiorella Salerno, MD

Electrophysiologist
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
LF

Laurent Fiorina, MD

Electrophysiologist
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
VM

Vladimir Manenti, MD

Electrophysiologist
Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
AZ

Amir Zouaghi, MD

Electrophysiologist
Service de Cardiologie, Hôpital Lariboisière – APHP, Paris, France
AF

Alyssa Faradji, MD

Radiologist
Hôpital Lariboisière – APHP, Paris, France
MN

Martin Nicol, MD

Cardiologist
Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière – APHP, France
TA

Tania Ah-Sing, MD

Radiologist
Service de Radiologie, Hôpital Lariboisière – APHP, Paris, France., France
JD

Jean Guillaume Dillinger, MD, PhD

Cardiologist
Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière – APHP, France
PH

Patrick Henry, MD, PhD

Head of the Department
Université de Paris Cité, Service de Cardiologie, Hôpital Lariboisière – APHP, France
PG

Philippe Garot, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
VB

Valérie Bousson, MD, PhD

Head of the Department
Service de Radiologie, Hôpital Lariboisière – APHP, Paris, France
Jerome Garot, PhD

Head
ICPS - Massy
Massy, Ile-de-France, France

Background:

While some studies have suggested a good feasibility and safety of vasodilator stress CMR in patients with PM, its prognostic value in this specific population was not well established with only a few single-centre studies with limited sample size. Indeed, these patients have been frequently excluded from the large studies showing the excellent prognostic value of stress CMR in patients with suspected or known CAD.

Therefore, the aim of the study was to assess the safety, feasibility, and prognostic value of stress cardiovascular magnetic resonance (CMR) in patients with pacemaker (PM).

Methods:

Between 2008 and 2021, we conducted a bi-centre longitudinal study with all consecutive patients with MR-conditional PM referred for vasodilator stress CMR at 1.5T in the Institut Cardiovasculaire Paris Sud and Lariboisiere University Hospital. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or nonfatal myocardial infarction. Cox regressions analyses were performed to determine the prognostic value of CMR-parameters. The quality of CMR was rated by two observers blinded to clinical details.

Results:

Of 304 patients who completed the CMR protocol, 273 patients (70% male, mean age 71±9 years) completed the follow-up (median [interquartile range], 7.1 [5.4-7.5] years). Among those, 32 experienced a MACE (11.7%). Stress CMR was well tolerated with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.9% of segments. Ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.71 [95% CI, 4.60-28.2]; and HR: 5.62 [95% CI, 2.02-16.21], both p< 0.001). After adjustment for traditional risk factors, ischaemia and LGE were independent predictors of MACE (HR: 5.08 [95% CI, 2.58-14.0]; and HR: 2.28 [95% CI, 2.05-3.76]; both p< 0.001).

Conclusion:

Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.