Imaging of Clinically Unrecognized Myocardial Fibrosis in Patients With Suspected Coronary Artery Disease.

Details

Serval ID
serval:BIB_6C519D620613
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Imaging of Clinically Unrecognized Myocardial Fibrosis in Patients With Suspected Coronary Artery Disease.
Journal
Journal of the American College of Cardiology
Author(s)
Antiochos P., Ge Y., Steel K., Bingham S., Abdullah S., Mikolich J.R., Arai A.E., Bandettini W.P., Patel A.R., Farzaneh-Far A., Heitner J.F., Shenoy C., Leung S.W., Gonzalez J.A., Shah D.J., Raman S.V., Ferrari V.A., Schulz-Menger J., Stuber M., Simonetti O.P., Kwong R.Y.
Working group(s)
SPINS Study Investigators
ISSN
1558-3597 (Electronic)
ISSN-L
0735-1097
Publication state
Published
Issued date
25/08/2020
Peer-reviewed
Oui
Volume
76
Number
8
Pages
945-957
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Stress cardiac magnetic resonance (CMR) provides accurate assessment of both myocardial infarction (MI) and ischemia.
This study aimed to evaluate the incremental prognostic value of unrecognized myocardial infarction (UMI), detected during assessment of coronary artery disease (CAD) by stress CMR, beyond cardiac function and ischemia.
In the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, 2,349 consecutive patients (63 ± 11 years of age, 53% were male) with suspected CAD were assessed by stress CMR and followed over a median of 5.4 years. UMI was defined as the presence of late gadolinium enhancement consistent with MI in the absence of medical history of MI. This study investigated the association of UMI with all-cause mortality and nonfatal MI (death and/or MI), and major adverse cardiac events (MACE).
UMI was detected in 347 patients (14.8%) and clinically recognized myocardial infarction (RMI) in 358 patients (15.2%). Compared with patients with RMI, patients with UMI had a similar burden of cardiovascular risk factors, but significantly lower left ventricular ejection fraction (p < 0.001) and lower rates of guideline-directed medical therapies, including aspirin (p < 0.001), statin (p < 0.001), and beta-blockers (p = 0.002). During follow-up, 328 deaths and/or MIs and 528 MACE occurred. In univariate analysis, UMI and RMI were strongly associated with death and/or MI (UMI: hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.63 to 2.83; p < 0.001; RMI: HR: 2.45; 95% CI: 1.89 to 3.18) and MACE. Compared with patients with RMI, patients with UMI presented an increased risk for heart failure hospitalization (UMI vs. RMI: HR: 2.60; 95% CI: 1.48 to 4.58; p < 0.001). In a multivariate model including ischemia and left ventricular ejection fraction, UMI and RMI maintained robust prognostic association with death and/or MI (UMI: HR: 1.82; 95% CI: 1.37 to 2.42; p < 0.001; RMI: HR: 1.54; 95% CI: 1.14 to 2.09) and MACE.
In a multicenter cohort of patients with suspected CAD, presence of UMI or RMI portended an equally significant risk for death and/or MI, independently of the presence of ischemia. Compared with RMI patients, those with UMI were less likely to receive guideline-directed medical therapies and presented an increased risk for heart failure hospitalization that warrants further study. (Stress CMR Perfusion Imaging in the United States [SPINS]; NCT03192891).
Keywords
Asymptomatic Diseases, Contrast Media/pharmacology, Coronary Artery Disease/diagnosis, Coronary Artery Disease/mortality, Coronary Artery Disease/physiopathology, Female, Gadolinium/pharmacology, Humans, Image Enhancement/methods, Magnetic Resonance Angiography/methods, Male, Middle Aged, Myocardial Infarction/diagnosis, Myocardial Infarction/mortality, Myocardial Infarction/physiopathology, Myocardial Ischemia/diagnosis, Myocardial Ischemia/physiopathology, Myocardial Perfusion Imaging/methods, Outcome and Process Assessment, Health Care, Prognosis, Risk Assessment, coronary artery disease, secondary prevention, silent myocardial infarction, stress cardiac magnetic resonance, unrecognized myocardial infarction
Pubmed
Web of science
Open Access
Yes
Create date
18/10/2022 9:37
Last modification date
06/04/2024 7:23
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