Stress cardiac magnetic resonance for mortality prediction and decision-making: registry of 2496 elderly patients with chronic coronary syndrome
Rev Esp Cardiol (Engl Ed). 2022 Mar;75(3):223-231.
doi: 10.1016/j.rec.2021.08.004.
Epub 2021 Sep 20.
[Article in
English,
Spanish]
Authors
Ana Gabaldón-Pérez
1
, Clara Bonanad
2
, Sergio García-Blas
3
, José Gavara
4
, César Ríos-Navarro
4
, Nerea Pérez-Solé
4
, Elena de Dios
4
, Víctor Marcos-Garcés
1
, Héctor Merenciano-González
1
, José V Monmeneu
5
, María P López-Lereu
5
, Julio Núñez
6
, Francisco J Chorro
6
, Vicente Bodí
7
Affiliations
- 1 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
- 2 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico de Valencia (INCLIVA), Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain. Electronic address: clarabonanad@gmail.com.
- 3 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico de Valencia (INCLIVA), Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain.
- 4 Instituto de Investigación Sanitaria del Hospital Clínico de Valencia (INCLIVA), Valencia, Spain.
- 5 Unidad de Resonancia Magnética Cardiovascular, ERESA, Valencia, Spain.
- 6 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico de Valencia (INCLIVA), Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
- 7 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico de Valencia (INCLIVA), Valencia, Spain; Departamento de Medicina, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain. Electronic address: vicente.bodi@uv.es.
Abstract
Introduction and objectives:
The management of elderly patients with chronic coronary syndrome (CCS) is challenging. We explored the prognostic value and usefulness for decision-making of ischemic burden determined by vasodilator stress cardiac magnetic resonance (CMR) imaging in elderly patients with known or suspected CCS.
Methods:
The study group comprised 2496 patients older than 70 years who underwent vasodilator stress CMR for known or suspected CCS. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Subsequently, we retrospectively analyzed its association with all-cause mortality and the effect of CMR-guided revascularization.
Results:
During a median follow-up of 4.58 years, there were 430 deaths (17.2%). A higher ischemic burden was an independent predictor of mortality (HR, 1.04; 95%CI, 1.01-1.07 for each additional ischemic segment; P=.006). This association was also found in patients older than 80 years and in women (P <.001). An interaction between revascularization and mortality was detected toward deleterious consequences at low ischemic burden and a protective effect in patients with extensive ischemia.
Conclusions:
Vasodilator stress CMR is a valuable tool to stratify risk in elderly patients with CCS and might be helpful to guide decision-making in this scenario.
Keywords:
Chronic coronary syndrome; Elderly; Paciente mayor; Resonancia magnética cardiaca de estrés; Stress cardiac magnetic resonance; Síndrome coronario crónico.
Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
MeSH terms
-
Aged
-
Coronary Artery Disease*
-
Female
-
Humans
-
Magnetic Resonance Imaging / methods
-
Magnetic Resonance Imaging, Cine / methods
-
Magnetic Resonance Spectroscopy
-
Predictive Value of Tests
-
Prognosis
-
Registries
-
Retrospective Studies
-
Risk Factors
-
Vasodilator Agents