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Fu Q, Alabed S, Hoole SP, Abraham G, Weir-McCall JR. Prognostic Value of Stress Perfusion Cardiac MRI in Cardiovascular Disease: A Systematic Review and Meta-Analysis of the Effects of the Scanner, Stress Agent, and Analysis Technique. Radiol Cardiothorac Imaging 2024; 6:e230382. [PMID: 38814186 PMCID: PMC11211944 DOI: 10.1148/ryct.230382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
Purpose To perform a systematic review and meta-analysis to assess the prognostic value of stress perfusion cardiac MRI in predicting cardiovascular outcomes. Materials and Methods A systematic literature search from the inception of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure until January 2023 was performed for articles that reported the prognosis of stress perfusion cardiac MRI in predicting cardiovascular outcomes. The quality of included studies was assessed using the Quality in Prognosis Studies tool. Reported hazard ratios (HRs) of univariable regression analyses with 95% CIs were pooled. Comparisons were performed across different analysis techniques (qualitative, semiquantitative, and fully quantitative), magnetic field strengths (1.5 T vs 3 T), and stress agents (dobutamine, adenosine, and dipyridamole). Results Thirty-eight studies with 58 774 patients with a mean follow-up time of 53 months were included. There were 1.9 all-cause deaths and 3.5 major adverse cardiovascular events (MACE) per 100 patient-years. Stress-inducible ischemia was associated with a higher risk of all-cause mortality (HR: 2.55 [95% CI: 1.89, 3.43]) and MACE (HR: 3.90 [95% CI: 2.69, 5.66]). For MACE, pooled HRs of qualitative, semiquantitative, and fully quantitative methods were 4.56 (95% CI: 2.88, 7.22), 3.22 (95% CI: 1.60, 6.48), and 1.78 (95% CI: 1.39, 2.28), respectively. For all-cause mortality, there was no evidence of a difference between qualitative and fully quantitative methods (P = .79). Abnormal stress perfusion cardiac MRI findings remained prognostic when subgrouped based on underlying disease, stress agent, and field strength, with HRs of 3.54, 2.20, and 3.38, respectively, for all-cause mortality and 3.98, 3.56, and 4.21, respectively, for MACE. There was no evidence of subgroup differences in prognosis between field strengths or stress agents. There was significant heterogeneity in effect size for MACE outcomes in the subgroups assessing qualitative versus quantitative stress perfusion analysis, underlying disease, and field strength. Conclusion Stress perfusion cardiac MRI is valuable for predicting cardiovascular outcomes, regardless of the analysis method, stress agent, or magnetic field strength used. Keywords: MR-Perfusion, MRI, Cardiac, Meta-Analysis, Stress Perfusion, Cardiac MR, Cardiovascular Disease, Prognosis, Quantitative © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Qing Fu
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Samer Alabed
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Stephen P. Hoole
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - George Abraham
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Jonathan R. Weir-McCall
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
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2
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Patel AR, Kramer CM. Perfusion Imaging for the Heart. Magn Reson Imaging Clin N Am 2024; 32:125-134. [PMID: 38007275 DOI: 10.1016/j.mric.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
The use of myocardial perfusion imaging during a stress cardiac magnetic resonance (CMR) examination for the evaluation of coronary artery disease is now recommended by both US and European guidelines. Several studies have demonstrated high diagnostic accuracy for the detection of hemodynamically significant coronary artery disease. Stress perfusion CMR has been shown to be a noninvasive and cost-effective alternative to guide coronary revascularization.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA.
| | - Christopher M Kramer
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA
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3
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Pezel T, Garot P, Toupin S, Sanguineti F, Hovasse T, Unterseeh T, Champagne S, Morisset S, Chitiboi T, Jacob AJ, Sharma P, Venkatesh BA, Lima JAC, Garot J. AI-Based Fully Automated Left Atrioventricular Coupling Index as a Prognostic Marker in Patients Undergoing Stress CMR. JACC Cardiovasc Imaging 2023; 16:1288-1302. [PMID: 37052568 DOI: 10.1016/j.jcmg.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. Its prognostic value is not established in patients with cardiovascular disease. OBJECTIVES This study sought to determine in patients undergoing stress cardiac magnetic resonance (CMR) whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF. METHODS Between 2016 and 2018, the authors conducted a longitudinal study including all consecutive patients with abnormal (inducible ischemia or late gadolinium enhancement) vasodilator stress CMR. Control subjects with normal stress CMR were selected using propensity score matching. LACI was defined as the ratio of left atrial to left ventricular end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death. Cox regression was used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors. RESULTS In 2,134 patients (65 ± 12 years, 77% men, 1:1 matched patients [1,067 with normal and 1,067 with abnormal CMR]), LACI was positively associated with the primary outcome (median follow-up: 5.2 years [IQR: 4.8-5.5 years]) before and after adjustment for risk factors in the overall propensity-matched population (adjusted HR: 1.18 [95% CI: 1.13-1.24]), in patients with abnormal CMR (adjusted HR per 0.1% increment: 1.22 [95% CI: 1.14-1.30]), and in patients with normal CMR (adjusted HR per 0.1% increment: 1.12 [95% CI: 1.05-1.20]) (all P < 0.001). After adjustment, a higher LACI of ≥25% showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-index improvement: 0.16; net reclassification improvement = 0.388; integrative discrimination index = 0.153, all P < 0.001; likelihood ratio test P < 0.001). CONCLUSIONS LACI is independently associated with hospitalization for HF and cardiovascular death in patients undergoing stress CMR, with an incremental prognostic value over traditional risk factors including inducible ischemia and late gadolinium enhancement.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Solenn Toupin
- Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Morisset
- Independent Biostatistician, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Athira J Jacob
- Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Puneet Sharma
- Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Bharath Ambale Venkatesh
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
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Bergamaschi L, Pavon AG, Angeli F, Tuttolomondo D, Belmonte M, Armillotta M, Sansonetti A, Foà A, Paolisso P, Baggiano A, Mushtaq S, De Zan G, Carriero S, Cramer MJ, Teske AJ, Broekhuizen L, van der Bilt I, Muscogiuri G, Sironi S, Leo LA, Gaibazzi N, Lovato L, Pontone G, Pizzi C, Guglielmo M. The Role of Non-Invasive Multimodality Imaging in Chronic Coronary Syndrome: Anatomical and Functional Pathways. Diagnostics (Basel) 2023; 13:2083. [PMID: 37370978 DOI: 10.3390/diagnostics13122083] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact. Currently, various guidelines and recommendations have been published about chronic coronary syndromes (CCS). According to the recent European Society of Cardiology guidelines on chronic coronary syndrome, a multimodal imaging approach is strongly recommended in the evaluation of patients with suspected CAD. Today, in the current practice, non-invasive imaging methods can assess coronary anatomy through coronary computed tomography angiography (CCTA) and/or inducible myocardial ischemia through functional stress testing (stress echocardiography, cardiac magnetic resonance imaging, single photon emission computed tomography-SPECT, or positron emission tomography-PET). However, recent trials (ISCHEMIA and REVIVED) have cast doubt on the previous conception of the management of patients with CCS, and nowadays it is essential to understand the limitations and strengths of each imaging method and, specifically, when to choose a functional approach focused on the ischemia versus a coronary anatomy-based one. Finally, the concept of a pathophysiology-driven treatment of these patients emerged as an important goal of multimodal imaging, integrating 'anatomical' and 'functional' information. The present review aims to provide an overview of non-invasive imaging modalities for the comprehensive management of CCS patients.
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Affiliation(s)
- Luca Bergamaschi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Domenico Tuttolomondo
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giulia De Zan
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maarten-Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Lysette Broekhuizen
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Marco Guglielmo
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
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5
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Said MA, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Garot P, Bousson V, Garot J. Safety, feasibility, and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. Eur Heart J Cardiovasc Imaging 2023; 24:202-211. [PMID: 36214336 DOI: 10.1093/ehjci/jeac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To assess the safety, feasibility, and prognostic value of stress cardiovascular magnetic resonance (CMR) in patients with pacemaker (PM). METHODS AND RESULTS Between 2008 and 2021, we conducted a bi-centre longitudinal study with all consecutive patients with MR-conditional PM referred for vasodilator stress CMR at 1.5 T in the Institut Cardiovasculaire Paris Sud and Lariboisiere University Hospital. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction. Cox regression analyses were performed to determine the prognostic value of CMR parameters. The quality of CMR was rated by two observers blinded to clinical details. Of 304 patients who completed the CMR protocol, 273 patients (70% male, mean age 71 ± 9 years) completed the follow-up (median [interquartile range], 7.1 [5.4-7.5] years). Among those, 32 experienced a MACE (11.7%). Stress CMR was well tolerated with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.9% of segments. Ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.71 [95% CI: 4.60-28.2]; and HR: 5.62 [95% CI: 2.02-16.21], both P < 0.001). After adjustment for traditional risk factors, ischaemia and LGE were independent predictors of MACE (HR: 5.08 [95% CI: 2.58-14.0]; and HR: 2.28 [95% CI: 2.05-3.76]; both P < 0.001). CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.
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Affiliation(s)
- Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Lacotte
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Jérôme Horvilleur
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Mina Ait Said
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Fiorella Salerno
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Laurent Fiorina
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Vladimir Manenti
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Amir Zouaghi
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris, Service de Cardiologie, Department of Cardiology and Electrophysiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Alyssa Faradji
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Martin Nicol
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Tania Ah-Sing
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Valérie Bousson
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
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6
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Pezel T, Bonnet G, Kinnel M, Asselin A, Hovasse T, Unterseeh T, Champagne S, Sanguineti F, Toupin S, Garot P, Garot J. Clustering of patients with inconclusive non-invasive stress testing referred for vasodilator stress cardiovascular magnetic resonance. Arch Cardiovasc Dis 2022; 115:627-636. [PMID: 36376207 DOI: 10.1016/j.acvd.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inconclusive non-invasive stress testing is associated with impaired outcome. This population is very heterogeneous, and its characteristics are not well depicted by conventional methods. AIMS To identify patient subgroups by phenotypic unsupervised clustering, integrating clinical and cardiovascular magnetic resonance data to unveil pathophysiological differences between subgroups of patients with inconclusive stress tests. METHODS Between 2008 and 2020, consecutive patients with a first inconclusive non-invasive stress test referred for stress cardiovascular magnetic resonance were followed for the occurrence of major adverse cardiovascular events (defined as cardiovascular death or myocardial infarction). A cluster analysis was performed on clinical and cardiovascular magnetic resonance variables. RESULTS Of 1402 patients (67% male; mean age 70±11years) who completed the follow-up (median 6.5years, interquartile range 5.6-7.5years), 197 experienced major adverse cardiovascular events (14.1%). Three distinct phenogroups were identified based upon unsupervised hierarchical clustering of principal components: phenogroup 1=history of percutaneous coronary intervention with viable myocardial infarction and preserved left ventricular ejection fraction; phenogroup 2=atrial fibrillation with preserved left ventricular ejection fraction; and phenogroup 3=coronary artery bypass graft with non-viable myocardial scar and reduced left ventricular ejection fraction. Using survival analysis, the occurrence of major adverse cardiovascular events (P=0.007), cardiovascular mortality (P=0.002) and all-cause mortality (P<0.001) differed among the three phenogroups. Phenogroup 3 presented the worse prognosis. In each phenogroup, ischaemia was associated with major adverse cardiovascular events (phenogroup 1: hazard ratio 2.79, 95% confidence interval 1.61-4.84; phenogroup 2: hazard ratio 2.59, 95% confidence interval 1.69-3.97; phenogroup 3: hazard ratio 3.16, 95% confidence interval 1.82-5.49; all P<0.001). CONCLUSIONS Cluster analysis of clinical and cardiovascular magnetic resonance variables identified three phenogroups of patients with inconclusive stress testing, with distinct prognostic profiles.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; Department of Cardiology, Lariboisière Hospital, AP-HP, Inserm UMRS 942, University of Paris, 75010 Paris, France
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Marine Kinnel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | | | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Solenn Toupin
- Scientific Partnerships Division, Siemens Healthcare France, 93200 Saint-Denis, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France.
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Pezel T, Sanguineti F, Garot P, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, Faradji A, Ah-Sing T, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Machine-Learning Score Using Stress CMR for Death Prediction in Patients With Suspected or Known CAD. JACC Cardiovasc Imaging 2022; 15:1900-1913. [PMID: 35842360 DOI: 10.1016/j.jcmg.2022.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In patients with suspected or known coronary artery disease, traditional prognostic risk assessment is based on a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables. OBJECTIVES This study sought to investigate the feasibility and accuracy of ML using stress cardiac magnetic resonance (CMR) and clinical data to predict 10-year all-cause mortality in patients with suspected or known coronary artery disease, and compared its performance with existing clinical or CMR scores. METHODS Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 (IQR: 5.0-8.0) years included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. ML involved automated feature selection by random survival forest, model building with a multiple fractional polynomial algorithm, and 5 repetitions of 10-fold stratified cross-validation. The primary outcome was all-cause death based on the electronic National Death Registry. The external validation cohort of the ML score was performed in another center. RESULTS Of 31,752 consecutive patients (mean age: 63.7 ± 12.1 years, and 65.7% male), 2,679 (8.4%) died with 206,453 patient-years of follow-up. The ML score (ranging from 0 to 10 points) exhibited a higher area under the curve compared with Clinical and Stress Cardiac Magnetic Resonance score, European Systematic Coronary Risk Estimation score, QRISK3 score, Framingham Risk Score, and stress CMR data alone for prediction of 10-year all-cause mortality (ML score: 0.76 vs Clinical and Stress Cardiac Magnetic Resonance score: 0.68, European Systematic Coronary Risk Estimation score: 0.66, QRISK3 score: 0.64, Framingham Risk Score: 0.63, extent of inducible ischemia: 0.66, extent of late gadolinium enhancement: 0.65; all P < 0.001). The ML score also exhibited a good area under the curve in the external cohort (0.75). CONCLUSIONS The ML score including clinical and stress CMR data exhibited a higher prognostic value to predict 10-year death compared with all traditional clinical or CMR scores.
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Affiliation(s)
- Théo Pezel
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Francesca Sanguineti
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Philippe Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Solenn Toupin
- Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France
| | | | - Thomas Hovasse
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Alyssa Faradji
- Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Tania Ah-Sing
- Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Martin Nicol
- Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Lounis Hamzi
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jean Guillaume Dillinger
- Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Patrick Henry
- Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Valérie Bousson
- Service de Radiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jérôme Garot
- Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
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Garot J, Pezel T. What if a patient has CAD? Go to CMR! Arch Cardiovasc Dis 2021; 114:765-767. [PMID: 34776368 DOI: 10.1016/j.acvd.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 6, Avenue du Noyer Lambert, 91300 Massy, France.
| | - Théo Pezel
- Department of Cardiology, Lariboisière Hospital, AP-HP, Inserm UMRS 942, University of Paris, Paris, France
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9
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Garot J. Improving Risk Stratification of Patients With Known CAD. JACC Cardiovasc Imaging 2021; 15:72-74. [PMID: 34538629 DOI: 10.1016/j.jcmg.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France.
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Klem I, Cavalier JS. Vasodilator Stress Magnetic Resonance Imaging in Patients With Prior Myocardial Infarction. JACC Cardiovasc Imaging 2021; 14:2152-2154. [PMID: 34147445 DOI: 10.1016/j.jcmg.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Igor Klem
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA.
| | - Joanna S Cavalier
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
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