Anvesha Singh1, John P Greenwood2, Colin Berry3, Dana K Dawson4, Kai Hogrefe5, Damian J Kelly6, Vijay Dhakshinamurthy7, Chim C Lang8, Jeffrey P Khoo9, David Sprigings10, Richard P Steeds11, Michael Jerosch-Herold12, Stefan Neubauer13, Bernard Prendergast13, Bryan Williams14, Ruiqi Zhang15, Ian Hudson16, Iain B Squire1, Ian Ford15, Nilesh J Samani1, Gerry P McCann1. 1. Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK. 2. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, Leeds University, Leeds, LS2 9JT, UK. 3. BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK. 4. Cardiovascular Medicine Research Unit, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. 5. Cardiology department, Kettering General Hospital Foundation Trust, Rothwell Rd, Kettering NN16 8UZ, UK. 6. Cardiology department, Royal Derby Hospital, Uttoxeter Rd, Derby DE22 3NE, UK. 7. Cardiology department, University Hospital, Clifford Bridge Rd, Coventry CV2 2DX, UK. 8. Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. 9. Cardiology department, Grantham and district hospital, 101 Manthorpe Rd, Grantham NG31 8DG, UK. 10. Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK. 11. Cardiovascular Medicine, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK. 12. Brigham and Woman s Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115, USA. 13. Department of Cardiovascular Sciences, University of Oxford, Level 6 West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK. 14. Department of Cardiovascular Sciences, University College London, Gower St, Kings Cross, London WC1E 6BT, UK. 15. Roberston Centre for Bisotatistics, University of Glasgow, Level 11, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK. 16. Cardiology department, Glenfield Hospital, Groby road, Leicester LE3 9QP, UK.
Abstract
AIMS: To assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS. METHODS AND RESULTS: Multi-centre, prospective, observational study, with blinded analysis of CMR data. Patients underwent adenosine stress CMR, symptom-limited exercise testing (ETT) and echocardiography and were followed up for 12-30 months. The primary outcome was a composite of: typical AS symptoms necessitating referral for AVR, cardiovascular death and major adverse cardiovascular events. 174 patients were recruited: mean age 66.2 ± 13.34 years, 76% male, peak velocity 3.86 ± 0.56 m/s and aortic valve area index 0.57 ± 0.14 cm2/m2. A primary outcome occurred in 47 (27%) patients over a median follow-up of 374 (IQR 351-498) days. The mean MPR in those with and without a primary outcome was 2.06 ± 0.65 and 2.34 ± 0.70 (P = 0.022), while the incidence of a symptom-limited ETT was 45.7% and 27.0% (P = 0.020), respectively. MPR showed moderate association with outcome area under curve (AUC) = 0.61 (0.52-0.71, P = 0.020), as did exercise testing (AUC = 0.59 (0.51-0.68, P = 0.027), with no significant difference between the two. CONCLUSIONS: MPR was associated with symptom-onset in initially asymptomatic patients with AS, but with moderate accuracy and was not superior to symptom-limited exercise testing. ClinicalTrials.gov (NCT01658345). Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS. METHODS AND RESULTS: Multi-centre, prospective, observational study, with blinded analysis of CMR data. Patients underwent adenosine stress CMR, symptom-limited exercise testing (ETT) and echocardiography and were followed up for 12-30 months. The primary outcome was a composite of: typical AS symptoms necessitating referral for AVR, cardiovascular death and major adverse cardiovascular events. 174 patients were recruited: mean age 66.2 ± 13.34 years, 76% male, peak velocity 3.86 ± 0.56 m/s and aortic valve area index 0.57 ± 0.14 cm2/m2. A primary outcome occurred in 47 (27%) patients over a median follow-up of 374 (IQR 351-498) days. The mean MPR in those with and without a primary outcome was 2.06 ± 0.65 and 2.34 ± 0.70 (P = 0.022), while the incidence of a symptom-limited ETT was 45.7% and 27.0% (P = 0.020), respectively. MPR showed moderate association with outcome area under curve (AUC) = 0.61 (0.52-0.71, P = 0.020), as did exercise testing (AUC = 0.59 (0.51-0.68, P = 0.027), with no significant difference between the two. CONCLUSIONS: MPR was associated with symptom-onset in initially asymptomatic patients with AS, but with moderate accuracy and was not superior to symptom-limited exercise testing. ClinicalTrials.gov (NCT01658345). Published on behalf of the European Society of Cardiology. All rights reserved.
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