Alberto Esteban-Fernández1, Gorka Bastarrika2, Eduardo Castanon3, Isabel Coma-Canella4, Joaquín Barba-Cosials4, Marta Jiménez-Martín4, Francisco Alpendurada5, Juan José Gavira4, Pedro M Azcárate-Agüero6. 1. Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. Electronic address: athalbertus@gmail.com. 2. Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. 3. Departamento de Oncología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. 4. Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. 5. Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom. 6. Servicio de Cardiología, Hospital San Pedro, Logroño, La Rioja, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly. METHODS: We prospectively studied consecutive patients referred for stress CMR to rule out myocardial ischemia. The cutoff age for the elderly population was 70 years. Stress CMR study was performed according to standardized international protocols. Hypoperfusion severity was classified according to the number of affected segments: mild (1-2 segments), moderate (3-4 segments), or severe (> 4 segments). We analyzed the occurrence of major events during follow-up (death, acute coronary syndrome, or revascularization). Survival was studied with the Kaplan-Meier method and multivariate Cox regression models. RESULTS: Of an initial cohort of 333 patients, 110 were older than 70 years. In 40.9% patients, stress CMR was positive for ischemia. The median follow-up was 26 [18-37] months. In elderly patients there were 35 events (15 deaths, 10 acute coronary syndromes, and 10 revascularizations). Patients with moderate or severe ischemia were at a higher risk of events, adjusted for age, sex, and cardiovascular risk (HR, 3.53 [95%CI, 1.41-8.79]; P=.01). CONCLUSIONS: Moderate to severe perfusion defects in stress CMR strongly predict cardiovascular events in people older than 70 years, without relevant adverse effects.
INTRODUCTION AND OBJECTIVES: Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly. METHODS: We prospectively studied consecutive patients referred for stress CMR to rule out myocardial ischemia. The cutoff age for the elderly population was 70 years. Stress CMR study was performed according to standardized international protocols. Hypoperfusion severity was classified according to the number of affected segments: mild (1-2 segments), moderate (3-4 segments), or severe (> 4 segments). We analyzed the occurrence of major events during follow-up (death, acute coronary syndrome, or revascularization). Survival was studied with the Kaplan-Meier method and multivariate Cox regression models. RESULTS: Of an initial cohort of 333 patients, 110 were older than 70 years. In 40.9% patients, stress CMR was positive for ischemia. The median follow-up was 26 [18-37] months. In elderly patients there were 35 events (15 deaths, 10 acute coronary syndromes, and 10 revascularizations). Patients with moderate or severe ischemia were at a higher risk of events, adjusted for age, sex, and cardiovascular risk (HR, 3.53 [95%CI, 1.41-8.79]; P=.01). CONCLUSIONS: Moderate to severe perfusion defects in stress CMR strongly predict cardiovascular events in people older than 70 years, without relevant adverse effects.
Authors: Daniel E Forman; James A de Lemos; Leslee J Shaw; David B Reuben; Radmila Lyubarova; Eric D Peterson; John A Spertus; Susan Zieman; Marcel E Salive; Michael W Rich Journal: J Am Coll Cardiol Date: 2020-09-29 Impact factor: 24.094
Authors: Adina Carmen Ilie; Sabinne Marie Taranu; Ramona Stefaniu; Ioana Alexandra Sandu; Anca Iuliana Pislaru; Calina Anda Sandu; Ana-Maria Turcu; Ioana Dana Alexa Journal: Life (Basel) Date: 2022-07-27