Cardiovascular Magnetic Resonance

ABCIC

Editorial

Contemporary Non-Invasive Imaging in Chronic Coronary Syndrome: What Stress Cardiovascular Magnetic Resonance has to Offer

Isabella Leo et al. Laura Torres Araujo Chiara Bucciarelli-Ducci

Non-invasive cardiac imaging has an established diagnostic and prognostic role in patients with suspected or known ischemic heart disease (IHD) and the imaging technology has significantly evolved over the years. Cardiovascular magnetic resonance (CMR) has emerged as a robust diagnostic and prognostic imaging modality and it currently represents a valid alternative to other existing and well-validated techniques, but also as a possible first-line strategy.

Major clinical practice guidelines have been increasingly incorporating stress CMR as a clinical test indicated in patients with chest pain, receiving a Class I recommendation first in the 2014 European Society of Cardiology (ESC) guidelines for revascularisation, followed by the 2017 ESC guidelines in the diagnosis and management of ST-elevation myocardial infarction which has been recommending CMR as an alternative test for left ventricular (LV) function when echocardiography is suboptimal, but also for the evaluation of myocardial viability and ischemia. The recently published 2021 American Heart Association (AHA)/American College of Cardiology (ACC) Guidelines also indicate stress CMR with class I recommendation in patients with acute and chronic chest pain and intermediate risk of coronary artery disease (CAD) ( ).

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ABC

Original Article

Prognostic Value of Aortic Stiffness using Cardiovascular Magnetic Resonance in The Elderly with Known or Suspected Coronary Artery Disease

Yodying Kaolawanich et al. Thananya Boonyasirinant

Abstract

Background

Aortic stiffness is established as a marker of cardiovascular disease. Cardiovascular magnetic resonance (CMR) provides a comprehensive assessment of aortic stiffness and myocardial ischemia in a single examination. However, prognostic data concerning aortic stiffness in elderly patients remain limited.

Objective

To determine the prognostic value of aortic stiffness using CMR-based pulse wave velocity (PWV) in elderly patients with known or suspected coronary artery disease (CAD).

Methods

This study enrolled consecutive patients aged >70 referred for adenosine stress perfusion CMR including PWV between 2010 and 2014. Patients were followed up for occurrence of major adverse cardiovascular events (MACE), including cardiac mortality, nonfatal myocardial infarction, hospitalization for heart failure, late revascularization (>180 days after CMR), and ischemic stroke. Univariable and multivariable analyses were performed to determine the predictors of MACE. A p-value of <0.05 is considered statistically significant.

Results

Mean PWV was 13.98±9.00 m/s. After a median follow-up period of 59.6 months in 263 patients (55% female, 77±5 years), 61 MACE occurred. Patients with elevated PWV (>13.98 m/s) had significantly higher rates of MACE (HR 1.75; 95% CI 1.05-2.94; p=0.03) than those with non-elevated PWV (<13.98 m/s). Multivariate analysis demonstrated diastolic blood pressure, left ventricular ejection fraction (LVEF), myocardial ischemia, and elevated PWV as independent predictors for MACE (p<0.05 for all). PWV provided an incremental prognostic value over clinical data, LVEF, and ischemia (increased global chi-square=7.25, p=0.01).

Conclusion

Aortic stiffness using CMR is a strong and independent predictor of cardiovascular events in elderly patients with known or suspected CAD.