CAD: Chronic Coronary Syndromes

1348669 - Safety and Incremental Prognostic Value of Stress CMR in Patients with Known Chronic Kidney Disease

Thursday, January 26, 2023

1:00 PM – 2:00 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)

TU

Thierry Unterseeh, MD

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

Thomas Hovasse, 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
PG

Philippe Garot, MD

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

Stéphane Champagne, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), 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
TA

Tania Ah-Sing, MD

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

Lounis Hamzi, MD

Radiologist
Service de Radiologie, Hôpital Lariboisière – APHP, Paris, 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
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:

Cardiovascular disease (CVD) is the main cause of mortality in patients with chronic kidney disease (CKD). Although several studies have demonstrated the consistently high prognostic value of stress cardiovascular magnetic resonance (CMR), its prognostic value in patients with CKD is not well established.

We aimed to assess the safety and the incremental prognostic value of vasodilator stress perfusion CMR in consecutive symptomatic patients with known CKD.

Methods:

Between 2008 and 2021, we conducted a bi-center longitudinal study with all consecutive symptomatic patients with known CKD, defined by estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m², referred for vasodilator stress CMR. All patients with eGFR < 30 ml/min/1.73 m² (n=62) were excluded due the risk of nephrogenic systemic fibrosis. All patients were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent nonfatal myocardial infarction (MI). Cox regressions were used to determine the prognostic value of stress CMR parameters.

Results:

Of 825 patients with known CKD (71.4±8.8 years, 70% men), 769 (93%) completed the CMR protocol, and among those 702 (91%) completed the follow-up (median follow-up 6.4 (4.0–8.2) years). Stress CMR was well tolerated without occurrence of death or severe adverse event related to the injection of gadolinium or nephrogenic systemic fibrosis case. The presence of inducible ischemia was associated with the occurrence of MACE (hazard ratio [HR] 12.50; 95% confidence interval [CI]: 7.50–20.8; p< 0.001). In multivariable analysis, ischemia and late gadolinium enhancement were independent predictors of MACE (HR 15.5; 95% CI: 7.72 to 30.9; and HR:4.67 [95%CI: 2.83-7.68]; respectively, both 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=0.477; IDI=0.049).

Conclusion:

In patients with known CKD, stress CMR is safe and its findings have an incremental prognostic value to predict MACE over traditional risk factors.