Incremental prognostic value of aortic stiffness in addition to myocardial ischemia by cardiac magnetic resonance imaging

Abstract

Background: Aortic stiffness is an independent predictor of cardiovascular (CV) events and mortality. However, no data exists for the prognosis of combined aortic stiffness and myocardial ischemia. Using cardiac magnetic resonance (CMR) imaging, we assessed the association of aortic stiffness by pulse wave velocity (PWV), myocardial ischemia, and CV events in patients with known or suspected coronary artery disease (CAD). Methods: Velocity-encoded CMR was performed in 520 patients who had undergone adenosine stress CMR. The PWV was determined between the mid-ascending and mid-descending thoracic aorta. Patients were divided into 4 groups by PWV (higher or lower PWV) and myocardial ischemia (positive or negative ischemia). Combined CV events including mortality, acute coronary syndrome, heart failure, coronary revascularization, and stroke were analyzed among the 4 groups. Results: The median follow-up period was 46.5 months, and the median PWV was 10.54 m/sec. Myocardial ischemia was positive in 199 patients (38.3%). The group with a higher PWV and positive ischemia had the most CV events (hazard ratio 8.94, p < 0.001). The group with a higher PWV and negative ischemia also was significantly associated with CV events (HR 2.19, p = 0.02). Groups with a lower PWV-positive ischemia and a higher PWV-negative ischemia showed no difference in terms of CV events (HR 0.60, p = 0.08). Patients with myocardial ischemia who had higher PWV demonstrated significantly higher event rates than those who had lower PWV (HR 2.41, p < 0.001). Multivariate analysis demonstrated that myocardial ischemia and PWV were independent predictors for combined CV events (HR 2.71, p < 0.001 and HR 2.42, p < 0.001, respectively). Conclusions: Stress perfusion CMR provided prognostic utility in patients with known or suspected CAD. Adding aortic stiffness to stress perfusion CMR could improve risk assessment and prediction for future CV events.

Impact of aortic stiffness by velocity-encoded magnetic resonance imaging on late gadolinium enhancement to predict cardiovascular events

“…Increased aortic stiffness was shown to have prognostic significance in healthy subjects and patients who had cardiovascular diseases, including CAD and non-ischemic cardiomyopathy such as hypertrophic cardiomyopathy [3] , [4] , [5] , [35] . A few studies demonstrated the prognostic value of aortic stiffness assessed by CMR for patients with stable CAD or post STEMI [36] , [37] . However, research focusing on the prognostic value of combined aortic stiffness and LGE is lacking.…”

Incremental value of the measures of arterial stiffness in cardiovascular risk assessment

“…Kaolawanich et al [60] investigated 520 patients who underwent adenosine stress cardiac magnetic resonance (CMR) and demonstrated that aortic PWV measured by CMR had incremental prognostic value to CMR results in the prediction of cardiovascular (CV) events during the median follow-up period of 46.5 months. In that study, patients with a higher PWV and positive ischemia on CMR had a significantly higher event rate compared to those with a lower PWV and negative ischemia (HR [hazard ratio], 8.94; p < 0.001).…”

“…Studies showing incremental prognostic value of the measures of arterial stiffness are summarized in Table 1 (Ref. [24,[60][61][62][63][64][65][66][67][69][70][71]).…”

Contemporary Role of Cardiac Magnetic Resonance in the Management of Patients with Suspected or Known Coronary Artery Disease

“…Moreover, the predictive values of coronary flow reserve (as assessed by CMR) and stress perfusion CMR for major adverse cardiovascular events were comparable in patients with known CAD [ 46 ]. Adding aortic stiffness (as expressed by pulse wave velocity) to stress CMR could improve prediction of mortality, acute coronary syndrome, heart failure, need for coronary revascularization and stroke [ 47 ]. Furthermore, it has been suggested that the implementation of a score combining clinical (age, sex, diabetes mellitus and left ventricular ejection fraction) and stress CMR data (ischemic burden defined as the number of segments with stress-induced perfusion defects) could predict the risk of long-term all-cause mortality in patients with known or suspected CAD [ 48 ].…”