Exercise ECG Testing and Stress Cardiac Magnetic Resonance for Risk Prediction in Patients With Chronic Coronary Syndrome.

Autores de INCLIVA

• 

  Victor Marcos Garcés

  Autor

• 

  Héctor Manuel Merenciano González

  Autor

• Ana Gabaldón Pérez

  Autor

• 

  Gonzalo Núñez Marín

  Autor

• 

  Miguel Lorenzo Hernández

  Autor

• Josep Gavara Doñate

  Autor

• César Rios Navarro

  Autor

• Elena Victoria De Dios Lluch

  Autor

• 

  Clara Bonanad Lozano

  Autor

• Paolo Racugno

  Autor

• 

  Francisco Javier Chorro Gascó

  Autor

• 

  Vicent Bodí Peris

  Autor

Participantes ajenos a INCLIVA

• Perez, Nerea
• Lopez-Lereu, Maria Pilar
• Monmeneu, Jose Vicente

Grupos y Plataformas de I+D+i

• Grupo de Investigación en Electrofisiología cardiaca experimental

  

  Leading Researcher

  Antonio M. Alberola Aguilar

• Grupo de Investigación Traslacional en Cardiopatía Isquémica

  

  Leading Researcher

  Vicent Bodí Peris

Abstract

PURPOSE: Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear. METHODS: We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death. RESULTS: During a mean follow-up of 4.2 ± 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndrome, eight admissions for heart failure, and four all-cause deaths). Once adjusted for clinical, ExECG, and VS-CMR parameters associated with SAE, the only independent predictors were HRmax in ExECG (HR = 0.98: 95% CI, 0.96-0.99; P = .01) and more extensive stress-induced perfusion defects (PDs, number of segments) in VS-CMR (HR = 1.19: 95% CI, 1.07-1.34; P < .01). Adding HRmax significantly improved the predictive power of the multivariable model for SAE, including PDs (continuous reclassification improvement index: 0.47: 95% CI, 0.10-0.81; P < .05). The annualized SAE rate was 1% (if PD < 2 segments and HRmax > 130 bpm), 2% (if PD < 2 segments and HRmax = 130 bpm), 3.2% (if PD = 2 segments and HRmax > 130 bpm), and 6.3% (if PD = 2 segments and HRmax = 130 bpm), P < .01, for the trend. In patients on ß-blocker therapy, however, only PDs in VS-CMR, but not HRmax, predicted SAE. CONCLUSIONS: We conclude that ExECG contributes significantly to prognostic information beyond VS-CMR in patients with known or suspected CCS.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

• all-cause mortality; heart rate; perfusion defect; prognosis; stable coronary artery disease