CAD: Chronic Coronary Syndromes
Theo Pezel, MD
Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France
Theo Pezel, MD
Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France
Philippe Garot, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Thierry Unterseeh, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Thomas Hovasse, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Francesca Sanguineti, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Solenn Toupin, PhD
Clinical scientist
Siemens Healthcare France, Scientific partnerships, Saint-Denis
Bordeaux, Aquitaine, France
Stéphane Morisset
Biostatistician
Hôpital Lariboisière – APHP, France
Stéphane Champagne, MD
Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
Jerome Garot, PhD
Head
ICPS - Massy
Massy, Ile-de-France, France
Stress cardiovascular magnetic resonance (CMR) is accurate and cost-effective for risk stratification. In patients with suspected coronary artery disease (CAD), studies have shown the excellent negative predictive value of a normal stress CMR with a 3-year annual event rate < 1%. Although, current guidelines state that it is possible to propose a non-invasive stress test to detect silent ischemia in an asymptomatic patient every 3 to 5 years, no study has formally evaluated serial stress CMR assessment in asymptomatic patients. This study aimed to assess the prognostic yield of serial follow-up by stress CMR in asymptomatic high-risk patients.
Methods:
From 2008 to 2018, we conducted a study with retrospective enrolment of all consecutive asymptomatic patients with ≥2 cardiovascular risk factors, but without known CAD, who underwent a normal index stress CMR (1.5T). Normal stress CMR was defined by the absence of ischemia or late-gadolinium enhancement (LGE). The follow-up consisted of yearly clinical visits and additional contacts in case of events. The primary outcome was all-cause death using the electronic French National Registry of Death. The association between a second stress CMR, analyzed as a time-dependent covariate, and the occurrence of death, was determined by: i) Cox analysis with covariables based on clinical input; and ii) a 1:1 propensity score-matched population (n=3,078 with only one CMR vs. n=3,078 with 2 serial CMR).
Results:
Among the 9,377 asymptomatic patients but without known CAD referred for stress CMR (66% men, age 63±12 years), 7,689 (82.0%) patients had a normal index CMR. Among those, 6,996 (91.0%) completed clinical follow-up and 3,086 were still asymptomatic and referred for a second stress CMR (44%, mean 3.7±1.2 years after index CMR), whereas 3,910 were not (56%). Overall, 578 (8.2%) patients died at median (IQR) follow-up of 6.8 (5.1-8.8) years. After adjustment, a serial study was independently associated with a lower rate of death (adjusted HR: 0.31; 95% CI: 0.24–0.42, p< 0.001, Figure 1A). There were no significant differences in baseline characteristics between the 2 groups matched on propensity score. In the propensity-matched populations, the performance of a second CMR study was associated with a lower death rate (HR: 0.35; 95% CI: 0.26–0.48, p< 0.001, Figure 1B). Consistently, after adjustment for the propensity score, a second CMR study was also associated with a lower death-rate (HR: 0.38; 95% CI: 0.27–0.53, p< 0.001). Finally, using the propensity score with the doubly robust method, a second CMR study was independently associated a lower death-rate (HR: 0.36; 95% CI: 0.29–0.43, p< 0.001).
Conclusion: To conclude, this study shows a potential clinical yield of serial follow-up by stress CMR every 3-5 years
in asymptomatic patients at high cardiovascular risk with a first normal index CMR and without known CAD.