TY - JOUR
T1 - Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis
T2 - the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) Study
AU - Singh, Anvesha
AU - Greenwood, John P
AU - Berry, Colin
AU - Dawson, Dana K
AU - Hogrefe, Kai
AU - Kelly, Damian J
AU - Dhakshinamurthy, Vijay
AU - Lang, Chim C
AU - Khoo, Jeffrey P
AU - Sprigings, David
AU - Steeds, Richard
AU - Jerosch-Herold, Michael
AU - Neubauer, Stefan
AU - Prendergast, Bernard
AU - Williams, Bryan
AU - Zhang, Ruiqi
AU - Hudson, Ian
AU - Squire, Iain B
AU - Ford, Ian
AU - Samani, Nilesh J
AU - McCann, Gerry P
PY - 2017/2/13
Y1 - 2017/2/13
N2 - AimsTo assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS.Methods and resultsMulti-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.ConclusionsMPR 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).
AB - AimsTo assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS.Methods and resultsMulti-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.ConclusionsMPR 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).
U2 - 10.1093/eurheartj/ehx001
DO - 10.1093/eurheartj/ehx001
M3 - Article
C2 - 28204448
SN - 0195-668X
JO - European Heart Journal
JF - European Heart Journal
ER -