1
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Toupin S, Pezel T, Hovasse T, Sanguineti F, Champagne S, Unterseeh T, Chitiboi T, Jacob A, Borgohain I, Sharma P, Garot P, Garot J. Incremental prognostic value of fully-automatic LVEF by stress CMR using machine learning. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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2
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Toupin S, Pezel T, Garot P, Sanguineti F, Kinnel M, Unterseeh T, Champagne S, Hovasse T, Garot J. Prognostic value of unrecognized myocardial infarction and silent ischemia detected by stress CMR in asymptomatic patients with prior cryptogenic ischemic stroke. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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3
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Pezel T, Hovasse T, Garot P, Sanguineti F, Champagne S, Unterseeh T, Toupin S, Ah-Sing T, Faradji A, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Incremental prognostic value of stress CMR for cardiovascular risk stratification in patients with known chronic kidney disease. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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4
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Ait Said M, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Bousson V, Garot P, Garot J. Safety, feasibility and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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5
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Pezel T, Hovasse T, Toupin S, Sanguineti F, Garot P, Champagne S, Chitiboi T, Jacob A, Borgohain I, Sharma P, Unterseeh T, Garot J. Additional prognostic value of fully automatic global longitudinal strain using machine learning. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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6
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Bohbot Y, Garot J, Hovasse T, Unterseeh T, Di Lena C, Boukefoussa W, Tawa C, Renard C, Limouzineau I, Duhamel S, Garot P, Tribouilloy C, Sanguineti F. Clinical and cardiovascular magnetic resonance predictors of early and long-term clinical outcome in acute myocarditis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
The natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are debated.
Purpose
We sought to assess the impact of various cardiac magnetic resonance (CMR) parameters on early and long-term prognosis in a population of patients with AM.
Methods
In a two-centre longitudinal study, we included consecutive patients with diagnosis of AM based on CMR and without haemodynamic compromise. The primary endpoint was the occurrence of an event in the acute phase (≤15 days). Secondary endpoints were the occurrence of major adverse cardiac events (MACE) and recurrence of AM during follow-up.
Results
Three hundred and eighty-eight patients were included (mean age 38.5 years, 77.3% male, mean ejection fraction [EF]:56%) of which 82% (317) presented with chest pain. CMR was performed 4±2 days after index presentation. Overall, 38 patients (9.8%) had an event at the acute phase, 41 (10.6%) presented at least one MACE during follow-up (median 7.5 years, 6.6–8.9) and 30 (7.7%) experienced a recurrence of AM. By multivariate analysis, the independent predictors of initial complications were absence of chest pain (OR [95% CI] = 0.35 [0.15–0.82]), presence of syncope/pre-syncope (OR [95% CI] = 3.56 [1.26–10.02]), lower EF (OR [95% CI] = 0.94 [0.91–0.98] per %), myocardial extent of late gadolinium enhancement (LGE) (OR [95% CI] = 1.05 [1.002–1.100] per %) and absence of edema (OR [95% CI] = 0.44 [0.19–0.97]). Only age (HR [95% CI] = 1.021 [1.001–1.041] per year) and an initial alteration of EF (HR [95% CI] = 0.94 [0.91–0.97] per %) were associated with MACE during follow-up. Factors independently associated with AM recurrence were myocarditis prior to the index episodes (HR [95% CI] = 5.74 [1.72–19.22]) and viral syndrome at the index episode (HR [95% CI] = 4.21 [1.91–9.28]).
Conclusion
In routine consecutive hemodynamically stable patients with diagnosis of AM based on CMR, absence of edema, reduced EF, and extent of LGE were associated with early adverse outcome. Only age and EF were associated with long-term events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - C Di Lena
- University Hospital of Amiens , Amiens , France
| | | | - C Tawa
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - C Renard
- University Hospital of Amiens , Amiens , France
| | | | - S Duhamel
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | | | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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7
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Pezel T, Sanguineti F, Garot P, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, 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. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In patients with suspected or known coronary artery disease (CAD), traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables.
Purpose
To investigate the feasibility and accuracy of ML using stress CMR and clinical data to predict 10-year all-cause mortality in patients with suspected or known CAD, and compared its performance to existing clinical or CMR scores.
Methods
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0–8.0) included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. Machine learning 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% males), 2,679 (8.4%) died with 206,453 patient-years of follow-up. ML score (ranging 0 to 10 points) exhibited a higher area-under-the-curve compared with C-CMR-10-score, ESC-score, QRISK3-score, FRS and stress CMR data alone for prediction of 10-year all-cause mortality (ML: 0.76 vs. C-CMR-10-score: 0.68, ESC-score: 0.66, QRISK3-score: 0.64, FRS: 0.63, extent of inducible ischemia: 0.66, extent of LGE: 0.65, all p<0.001). The ML score exhibited also a good area-under-the-curve in the external cohort (AUC: 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.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Toupin
- Siemens Healthcare France, MRI Department , Saint Denis , France
| | - S Morisset
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Ah-Sing
- Hospital Lariboisiere, Radiology , Paris , France
| | - M Nicol
- Hospital Lariboisiere, Cardiology , Paris , France
| | - L Hamzi
- Hospital Lariboisiere, Radiology , Paris , France
| | | | - P Henry
- Hospital Lariboisiere, Cardiology , Paris , France
| | - V Bousson
- Hospital Lariboisiere, Radiology , Paris , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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8
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Pezel T, Hovasse T, Lefevre T, Sanguineti F, Champagne S, Benamer H, Neylon A, Toupin S, Garot P, Chevalier B, Garot J. Incremental prognostic value of stress CMR in symptomatic patients with coronary stenosis on CCTA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Noninvasive functional imaging is often performed in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA). However, the prognostic value of stress cardiovascular magnetic resonance (CMR) is unknown in patients with coronary stenosis of unknown significance on CCTA.
Purpose
To assess the prognostic value of stress CMR in symptomatic patients with obstructive CAD of unknown significance on CCTA.
Methods
Between 2008–2020, consecutive symptomatic patients without known CAD referred for CCTA were screened. Patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) were further referred for stress CMR and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction.
Results
Of 2,210 patients who completed CMR, 2,038 (46.5% male, mean age 69.8±12.2 years) completed follow-up (median 6.8 [IQR 5.9–9.2] years); 281 experienced a MACE (13.8%). Inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with MACE (HR: 4.51, [95% CI: 3.55–5.74]; and HR: 3.32, [95% CI: 2.55–4.32], respectively; p<0.001). In multivariable Cox regression, number of segments with >70% stenosis, with noncalcified plaques and number of vessels with obstructive CAD were prognosticators (p<0.001). The presence of inducible ischemia and LGE were independent predictors of MACE (HR: 3.97, [95% CI: 3.43–5.13]; HR: 2.30, [95% CI: 1.52–3.33]; p<0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA (C-statistic improvement: 0.04; NRI=0.421; IDI=0.047).
Conclusions
In symptomatic patients with obstructive CAD of unknown significance on CCTA, stress CMR had incremental prognostic value to predict MACE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Lefevre
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - H Benamer
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - A Neylon
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Toupin
- Siemens Healthcare France, MRI Department , Saint Denis , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - B Chevalier
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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Pezel T, Toupin S, Sanguineti F, Kinnel M, Hovasse T, Unterseeh T, Champagne S, Garot P, Garot J. Incremental prognostic value of stress CMR for cardiovascular risk stratification after a cryptogenic ischemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
One-third of ischemic strokes are “cryptogenic” without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest of CAD screening in patients with cryptogenic stroke is still debated.
Purpose
The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.
Methods
Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.
Results
Of 542 patients (55.2% male, mean age 71.4±8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18% and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE (hazard ratio, HR: 8.43 [95% CI: 5.11–13.9]; HR: 7.87 [95% CI: 4.80–12.9]; respectively, p<0.001). In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE (HR: 8.08 [95% CI: 4.21–15.5]; HR: 6.65 [95% CI: 3.49–12.7]; respectively, p<0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.428; IDI=0.048).
Conclusions
In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere, Cardiology , Paris , France
| | - S Toupin
- Siemens Healthcare France, MRI Department , Saint Denis , France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
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10
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Yoon S, Fischer C, Toupin S, Pezel T, Garot J, Wetzl J, Maier A, Giese D. Fully automatic AI-based valve motion parameter extraction on long axis CINE images - application on N=11000 patient datasets. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Research support from Siemens Healthineers GmbH.
Background
Mitral valve (MV) motion parameters, assessable using CMR [1, 2], have been shown to help the diagnosis of cardiac dysfunction. To extract valve motion parameters, we propose a fully automatic AI-based prototype system that tracks annulus and apex landmarks by the registration network on time-resolved two- and four-chamber CMR cine views. Parameters such as displacements, velocities, mitral annular plane systolic excursion (MAPSE), or longitudinal shortening (LS) are automatically extracted and evaluated on a large CMR dataset (N=11000).
Methods
The system consists of two sequential neural networks with a processing step in between (Fig. 1a) [3]. Initially, a 2D UNet is applied to localize both MV annulus insertion points as well as the apex. Based on these points, the image processing step consists of rotating, cropping, and interpolating the images, allowing a standardized image impression for both long axis views. Finally, the registration network (VoxelMorph framework [4]) is applied to the processed series and tracks the MV annulus insertion points and apex over the cardiac cycle by the deformation fields obtained by the network. The system was trained on (N=166) multivendor, multi-field strength, ground-truth annotated datasets [5].
A total of 11000 datasets, acquired on a 1.5T scanner (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) from January 2016 to September 2017 [6], were used for parameter extraction. 200 of these datasets were additionally annotated semi-automatically for the performance evaluation of the system.
Five motion parameters were automatically derived by the system that are defined as follows (Fig. 1b): (1) The atrioventricular plane displacement (AVPD) as the distance of the plane spanned by the MV annulus points relative to the first frame, (2) the atrioventricular plane velocity (AVPV) as the discrete temporal derivate of the AVPD, (3) the diameter of the annulus as the maximum distance between the MV annulus points, (4) the lateral/inferior and septal/superior MAPSE, as the maximum MV points’ excursion, and (5) the LS as the percentage size difference of the distance between the mid valvular point and the apex point at end-systole and end-diastole.
Results
The accuracy of the system resulted in deviations on the annotated dataset of 1.02 ± 0.87 mm, 0.01 ± 0.02 mm/s, 1.54 ± 1.21 mm, 2.30 ± 1.35 mm, 2.1 ± 1.8 mm for AVPD, AVPV, diameter, MAPSE, and LS respectively. Initial statistics on all datasets (Fig. 2) revealed a mean lateral/inferior, septal/superior MAPSE and LS of 8.7 ± 2.7 mm, 10.5 ± 3.2 mm and 16.3 ± 4.2 % for two-chamber and 9.6 ± 2.6 mm, 8.7 ± 2.6 mm and 15.5 ± 3.9 % for four-chamber views, respectively.
Conclusions
The results demonstrate the versatility of the proposed system for automatic extraction of various MV motion parameters. The proposed system enables automatic extraction of clinically relevant parameters and can improve the automation of MV-based analyses. System overview & Parameter of interestsAnalysis of the extracted parameters
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Affiliation(s)
- S Yoon
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Pattern Recognition Lab , Erlangen , Germany
| | - C Fischer
- Technische Universität , Berlin , Germany
| | - S Toupin
- Siemens Healthcare France , Saint-Denis , France
| | - T Pezel
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS) , Massy , France
| | - J Wetzl
- Siemens Healthcare GmbH, Magnetic Resonance , Erlangen , Germany
| | - A Maier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Pattern Recognition Lab , Erlangen , Germany
| | - D Giese
- Siemens Healthcare GmbH, Magnetic Resonance , Erlangen , Germany
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11
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Pezel T, Sanguineti F, Garot P, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, Garot J. Machine-learning score using stress CMR for death prediction in patients with suspected or known CAD. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
In patients with suspected or known coronary artery disease (CAD), traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables.
PURPOSE
To investigate the feasibility and accuracy of ML using stress CMR and clinical data to predict 10-year all-cause mortality in patients with suspected or known CAD, and compared its performance to existing clinical or CMR scores.
METHODS
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0-8.0) included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. Machine learning 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.
RESULTS
Of 31,752 consecutive patients (mean age 63.7 ± 12.1 years and 65.7% males), 2,679 (8.4%) died with 206,453 patient-years of follow-up. ML score (ranging 0 to 10 points) exhibited a higher area-under-the-curve compared with C-CMR-10-score, ESC-score, QRISK3-score, FRS and stress CMR data alone for prediction of 10-year all-cause mortality (ML: 0.76 vs. C-CMR-10-score: 0.68, ESC-score: 0.66, QRISK3-score: 0.64, FRS: 0.63, extent of inducible ischemia: 0.66, extent of LGE: 0.65, all p < 0.001).
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. Abstract Figure. Random survival Forest: ML score Abstract Figure. Prognostic Value of ML score
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Affiliation(s)
- T Pezel
- The Johns Hopkins Hospital, Cardiology , Baltimore, United States of America
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - S Morisset
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
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12
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Pezel T, Unterseeh T, Hovasse T, Asselin A, Lefevre T, Chevalier B, Neylon A, Benamer H, Champagne S, Sanguineti S, Toupin S, Garot P, Garot J. Phenotypic clustering of patients with newly diagnosed coronary artery disease using cardiovascular magnetic resonance and coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Epidemiological characteristics and prognostic profiles of patients with newly diagnosed coronary artery disease (CAD) are heterogeneous. Thus, providing individualized cardiovascular (CV) risk stratification and tailored prevention is crucial.
PURPOSE
Phenotypic unsupervised clustering integrating clinical, coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) data was used to unveil pathophysiological differences between subgroups of patients with newly diagnosed CAD.
METHODS
Between 2008 and 2020, consecutive patients with newly diagnosed obstructive CAD on CCTA and further referred for vasodilator stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. A cluster analysis was performed on clinical, CCTA and CMR variables, and associations between phenogroups and outcomes were assessed.
RESULTS
Of 2,210 patients who underwent CMR, 2,015 (46% male, mean 70 ± 12 years) completed follow-up (median 6.8[IQR 5.9-9.2] years); 277 experienced a MACE (13.7%). Three mutually exclusive and clinically distinct phenogroups (PG) were identified based upon unsupervised hierarchical clustering of principal components: [PG1] CAD in elderly patients with few traditional risk factors; [PG2] women with metabolic syndrome, calcified plaques on CCTA and preserved left ventricular ejection fraction (LVEF); and [PG3] younger male smokers with proximal noncalcified plaques on CCTA, myocardial scar and reduced LVEF. Using survival analysis, the occurrence of MACE, cardiovascular mortality and all-cause mortality (all p < 0.001) differed among the three PG, PG3 having the worse prognosis. In each PG, inducible ischemia was associated with MACE (PG1, HR = 3.09, 95%CI, 1.70-5.62; PG2, HR = 3.62, 95%CI, 2.31-5.70; PG3, HR = 3.55, 95%CI, 2.30-5.49; all p < 0.001).
CONCLUSIONS
Cluster analysis of clinical, CCTA and CMR variables identified 3 phenogroups of patients with newly diagnosed CAD that were associated with distinct clinical and prognostic profiles. Inducible ischemia assessed by stress CMR remained associated with the occurrence of MACE within each phenogroup. Abstract Figure. Cluster analysis: Biplot representation Abstract Figure. Kaplan Meier curves by Phenogroups
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Affiliation(s)
- T Pezel
- The Johns Hopkins Hospital, Cardiology , Baltimore, United States of America
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - A Asselin
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - T Lefevre
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - B Chevalier
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - A Neylon
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - H Benamer
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - S Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
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Pezel T, Hovasse T, Lefevre T, Sanguineti F, Unterseeh T, Champagne S, Benamer H, Neylon A, Toupin S, Garot P, Chevalier B, Garot J. Incremental prognostic value of vasodilator stress cardiovascular magnetic resonance over coronary computed tomography angiography in symptomatic patients. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Current guidelines recommend to perform noninvasive functional imaging in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA). However, the prognostic value of stress cardiovascular magnetic resonance (CMR) over traditional risk factors and CCTA is not known.
PURPOSE
To assess the incremental prognostic value of stress CMR beyond traditional risk factors and CCTA in patients with obstructive CAD on CCTA.
METHODS
Between 2008 and 2020, consecutive symptomatic patients without known CAD referred for CCTA were screened. Among those, patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) and referred for functional stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions were performed to determine the prognostic value of CCTA and CMR findings.
RESULTS
Of 2,210 patients who completed the CMR protocol, 2,038 patients (46.5% male, mean age 69.8 ± 12.2 years) completed the follow-up (median 6.8 [IQR 5.9-9.2] years); 281 experienced a MACE (13.8%). Stress CMR was well tolerated without severe adverse events. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 4.51, [95%CI: 3.55-5.74]; and HR: 3.32, [95%CI: 2.55-4.32], respectively; both p < 0.001). In multivariable Cox regression, the presence of inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 3.97, [95%CI: 3.43-5.13]; HR: 2.30, [95%CI: 1.52-3.33]; respectively, both p < 0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C statistic improvement: 0.08; NRI = 0.421; IDI = 0.047).
CONCLUSIONS
In symptomatic patients with obstructive CAD of unknown significance on CCTA, stress CMR has an incremental prognostic value to predict MACE over traditional risk factors and CCTA findings. Abstract Figure. Kaplan-Meier curves for MACE Abstract Figure. Competitive risk analysis
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Affiliation(s)
- T Pezel
- The Johns Hopkins Hospital, Cardiology , Baltimore, United States of America
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - T Lefevre
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - H Benamer
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - A Neylon
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - B Chevalier
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Cardiology , Massy, France
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Pezel T, Unterseeh T, Garot P, Hovasse T, Sanguineti F, Toupin S, Morisset S, Champagne S, Garot J. Incremental long-term prognostic value of stress CMR above traditional risk factors to predict death a large registry with > 200,000 patient-years of follow-up. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Pezel T, Sanguineti F, Champagne S, Toupin S, Morisset S, Garot P, Garot J. Prognostic value of stress CMR-related coronary revascularization to predict death: A propensity score matching analysis a large registry with > 200,000 patient-years of follow-up. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Pezel T, Garot P, Sanguineti F, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, Garot J. Machine learning score using stress CMR for prediction of all-cause death in patients with suspected or known coronary artery disease a large registry with > 200,000 patient-years of follow-up. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Pezel T, Hovasse T, Lefevre T, Sanguineti F, Unterseeh T, Champagne S, Benamer H, Neylon A, Toupin S, Garot P, Chevalier B, Garot J. Incremental prognostic value of vasodilator stress cardiovascular magnetic resonance over coronary computed tomography angiography in symptomatic patients. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Pezel T, Unterseeh T, Garot P, Hovasse T, Kinnel M, Champagne S, Toupin S, Sanguineti F, Garot J. Prognostic interest of vasodilator stress perfusion cardiovascular magnetic resonance after a first inconclusive stress testing. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
While current guidelines recommend to perform a noninvasive test to detect coronary artery disease, stress tests are deemed inconclusive in almost a third of cases. The strategy for risk stratification after inconclusive stress testing is not well standardized.
PURPOSE
To assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters and CMR-based coronary revascularization in patients after inconclusive stress testing.
METHODS
Between 2008 and 2020, consecutive patients with a first inconclusive stress test referred for vasodilator stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. CMR-related coronary revascularization was defined as any revascularisation occurring within 90 days after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter.
RESULTS
Of 1,563 patients who completed the CMR protocol, 1,402 patients (66.7% male, mean age 69.5 ± 11.0 years) completed the follow-up (median[interquartile range], 6.5 [5.6-7.5] years); 197 experienced a MACE (14.1%). Stress CMR was well tolerated without severe adverse events. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 2.88 [95%CI, 2.18-3.81]; and HR: 1.46 [95%CI, 1.16-1.89], both p < 0.001; respectively). In multivariable Cox regression, the presence and extent of inducible ischemia were independent predictors of a higher incidence of MACE (HR: 2.53 [95%CI, 1.89-3.40]; and HR: 1.58 [95%CI, 1.47-1.71]; both p < 0.001; respectively). After adjustment, the extent of inducible ischemia showed the best improvement in model discrimination above traditional risk factors (C-statistic 0.75 [95%CI: 0.69-0.81] with C-statistic improvement: 0.12). The study showed no benefit of CMR-related coronary revascularization in reducing MACE.
CONCLUSION
In patients with a first inconclusive stress test, stress CMR has good prognostic value to predict MACE offering an incremental prognostic value over traditional risk factors.
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
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Moschetti K, Kwong RY, Petersen SE, Lombardi M, Garot J, Atar D, Rademakers FE, Sierra-Galan LM, Mavrogeni S, Li K, Lara Fernandes J, Antiochos P, Bruder O, Marholdt H, Schwitter J. Cost-Minimization analysis for cardiac revascularization in 12 healthcare systems based on the EuroCMR/SPINS registries. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): EuroCMR registry (Life Sciences GE Healthcare, Medtronic Inc., Minneapolis MN, USA; Novartis International AG, Basel, Switzerland; Siemens Healthcare, Erlangen, Germany), SPINS registry (Siemens Healthineers, Erlangen, Germany; Bayer AG, Leverkusen, Germany)
Background
Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion cardiac magnetic resonance (CMR) has an excellent accuracy to detect CAD, but data on its cost effectiveness are scarce.
Purpose
To compare the costs of a CMR-guided strategy vs 2 invasive strategies based on 2 large international CMR registries.
Methods
In the EuroCMR registry (n = 3’647, 59 centers, 18 countries) and the US-based SPINS registry (n = 2’349, 13 centers, 11 states) costs were calculated for 12 healthcare systems (8 Europe, US, 2 Latin America, 1 Asia). They included diagnostic examinations (CMR, X-ray coronarography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Endpoints in both registries were all-cause and cardiovascular (CV) death, sudden cardiac death (SCD), aborted SCD, non-fatal myocardial infarction (nf-MI), and stroke. 7 sub-group analyses covered low to high-risk cohorts. Patients with ischemia-positive CMR underwent CXA and revascularization (percuteneous and surgical intervention) at the treating physician’s discretion (=CMR + CXA-strategy). In the hypothetical invasive CXA + FFR-strategy, costs were calculated for an initial CXA and an FFR in vessels with ≥50% stenoses assuming the same proportion of revascularizations/complications as in the CMR + CXA-strategy and FFR positive rates as given in the literature. In the CXA-only strategy, costs included CXA and revascularizations of ≥50% stenoses.
Results
Revascularizations were performed in 8.0% and 6.2% (p < 0.01) of SPINS and EuroCMR patients, respectively. Consistent cost savings were observed for the CMR + CXA strategy vs CXA + FFR in all 12 healthcare systems ranging from 42 ± 20% and 52 ± 15% in the low-risk EuroCMR and SPINS patients with atypical chest pain (CV-death and nf-MI 0.4-0.7%/y), respectively, to 31 ± 16% in the high-risk SPINS patients (CV-death and nf-MI 3.2%/y) with known CAD (p < 0.0001 vs 0 in all groups, Fig 1/2). Cost savings were even higher vs CXA-only with 63 ± 11%, 73 ± 6%, and 52 ± 9%, respectively (p < 0.0001 vs 0 in all groups, Fig 2).
Conclusions
In 12 healthcare systems, a CMR + CXA-strategy yielded consistent moderate to high cost savings compared to a hypothetical CXA + FFR-strategy over the entire spectrum of risk. Cost savings were consistently high vs a CXA-only strategy for all risk groups.
Figure 1: SPINS refers to the subgroup of patients with suspected CAD (n = 1’530), EuroCMR (= suspected CAD; n = 3’647). EuroCMR vs SPINS ns. Countries per region are listed in alphabetical order.
Figure 2: Top: CMR + CXA vs CXA + FFR: ANOVA: overall p = 0.0017, * vs EuroCMR typ angina: p < 0.005 (Scheffe post-hoc testing). Bottom: CMR + CXA vs CXA-only: ANOVA overall p < 0.0001, * vs SPINS with CAD and vs EuroCMR typ A: p < 0.0001; † vs SPINS with CAD: p < 0.03; ‡ vs EuroCMR typ A: p < 0.0001; § vs SPINS with CAD: p < 0.002; ║ vs EuroCMR typ: p < 0.002 (Scheffe post-hoc tesing)
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Affiliation(s)
- K Moschetti
- Centre for Primary Care and Public Health (Unisante), Health Technology Assessment Unit, Lausanne, Switzerland
| | - RY Kwong
- Brigham And Women"S Hospital, Harvard Medical School, Boston, United States of America
| | - SE Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Center, Queen Mary University, London, United Kingdom of Great Britain & Northern Ireland
| | - M Lombardi
- I.R.C.C.S. Policlinics of San Donato, Milano, Italy
| | - J Garot
- Institut Cardiovasculaire Paris Sud, Hopital prive Jacques Cartier, Ramsay Santé, Paris, France
| | - D Atar
- Oslo University Hospital Ulleval, Institute of clinical sciences, University of Oslo, Oslo, Norway
| | | | - LM Sierra-Galan
- American British Cowdray Medical Center, Mexico City, Mexico
| | - S Mavrogeni
- Onassis Cardiac Surgery Center, Kapoditrian University of Athens, Athens, Greece
| | - K Li
- Xuan Wu Hospital Affiliated to Capital Medical University, Beijing, China
| | - J Lara Fernandes
- Campinas Medical Center, Jose Michel Kalaf Research Institute, Campinas, Brazil
| | - P Antiochos
- Brigham And Women"S Hospital, Harvard Medical School, Boston, United States of America
| | - O Bruder
- Ruhr University Bochum and Elisabeth Hospital, Cardiology and Angiology, Essen, Germany
| | - H Marholdt
- Robert Bosch Hospital, Stuttgart, Germany
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), University of Lausanne, UniL, Lausanne, Switzerland
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20
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Pezel T, Unterseeh T, Garot P, Hovasse T, Sanguineti F, Toupin S, Morisset S, Champagne S, Garot J. Long-term prognostic value of stress CMR-related coronary revascularization to predict death: a large registry with > 200,000 patient-years of follow-up. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
While the benefit of coronary revascularization in patients with stable coronary artery disease (CAD) is debated, data assessing the potential interest of stress CMR to guide coronary revascularization are limited.
PURPOSE
To assess the long-term prognostic value of stress CMR-related coronary revascularization in consecutive patients from a large registry.
METHODS
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0-8.0) included all consecutive patients referred for stress CMR. Stress CMR-related coronary revascularization was defined by any coronary revascularization performed within 90 days after CMR. The primary outcome was all-cause death based on the electronic National Death Registry.
RESULTS
Among the 31,752 consecutive patients (mean age 63.7 ± 12.1 years and 65.7% males), 2,679 (8.4%) died at 206,453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement (LGE) by CMR were associated with death (both p < 0.001). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of death (HR = 1.61; 99.5%CI 1.41-1.84; HR = 1.62; 99.5%CI 1.41-1.86, respectively; p < 0.001). CMR-related coronary revascularization was an independent predictor of greater survival (HR: 0.66; 99.5%CI: 0.52-0.84; p < 0.001). CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (p < 0.001), but showed no benefit in patients with mild or moderate ischemia (p = 0.109).
CONCLUSIONS
In this large observational series of consecutive patients, stress perfusion CMR had important incremental long-term prognostic value to predict death over traditional risk factors. CMR-related revascularization was associated with a lower incidence of death in patients with severe ischemia.
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - S Morisset
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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21
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Pezel T, Garot P, Hovasse T, Unterseeh T, Champagne S, Toupin S, Sanguineti F, Lima J, Garot J. Prognostic value of pre-hospitalization stress perfusion CMR to predict death in patients hospitalized for COVID-19. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344446 DOI: 10.1093/ehjci/jeab090.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. BACKGROUND Inducible ischemia is a strong marker of vascular vulnerability that may be a key pathogenetic determinant of COVID-19 severity. PURPOSE This study investigated the prognostic value of prior inducible ischemia on stress perfusion CMR to predict death in patients hospitalized for COVID-19. METHODS In an observational study, we retrospectively analyzed consecutive patients referred for stress perfusion CMR within last two years prior to hospitalization for COVID-19. The primary outcome was all-cause death, including in-hospital and post-hospitalisation deaths, based on the electronic national death registry. RESULTS Among the patients referred for stress perfusion CMR, 481 were hospitalized for COVID-19 (mean age =68.4 ± 9.6 years, 61.3% males) and completed the follow-up (median 73[36-101] days). There were 93 (19.3%) all-cause deaths, of which 13.7% were in-hospital and 5.6% post-hospitalisation deaths. Using Kaplan-Meier analysis, age, male gender, hypertension, diabetes, known CAD, the presence of prior inducible ischemia, the number of ischemic segments, the presence of LGE, and LVEF were significantly associated with all-cause death. In multivariable stepwise Cox regression analysis, age (HR: 1.04; 95%CI:1.01-1.07, p = 0.023), hypertension (HR: 2.77; 95%CI:1.71-4.51, p < 0.001), diabetes (HR: 1.72; 95%CI:1.08-2.74, p = 0.022), known CAD (HR: 1.78; 95%CI:1.07-2.94, p = 0.025) and the presence of prior inducible ischaemia (HR: 2.05; 95%CI:1.27-3.33, p = 0.004) were independent predictors of all-cause death. CONCLUSIONS In COVID-19 patients, prior inducible myocardial ischemia by stress CMR over the last two years preceding the COVID-19 pandemic was independently associated with all-cause in-hospital and post-hospitalisation deaths, suggesting involvement of vasculature and endothelial dysfunction in the severity of COVID-19.
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - J Lima
- The Johns Hopkins Hospital, Division of Cardiology, Baltimore, United States of America
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
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22
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Pezel T, Lacotte J, Toupin S, Garot P, Hovasse T, Unterseeh T, Sanguineti F, Ait Said M, Salerno F, Fiorina L, Manenti V, Horvilleur J, Garot J. Safety, feasibility and prognostic value of stress perfusion CMR in patients with pacemaker. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Several studies have shown the excellent prognostic value of stress cardiovascular magnetic resonance (CMR). However, its prognostic value in patients with pacemaker (PM) remains unknown because most studies excluded PM patients.
PURPOSE
This study aimed to assess the prognostic value of vasodilator stress perfusion CMR in patients with PM.
METHODS
Consecutive patients with MR-conditional pacemakers referred for stress perfusion CMR at 1.5 T were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Cox regressions analyses were performed to determine the prognostic value of CMR-parameters. The quality of CMR was rated by two observers blinded to clinical details. Data on pacemaker and leads were collected pre- and post-CMR.
RESULTS
Of 224 patients who completed the stress CMR protocol, 2 patients had inconclusive stress CMR due to artefact and 203 patients (72.9% male, mean age 71.4 ± 8.7 years) completed the follow-up (median [interquartile range], 7.0 [5.2-7.3] years). Among those, 23 experienced a MACE (11.3%). Stress CMR was well tolerated with no major adverse events. All scans were completed successfully with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.1% of segments. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.80 [95% CI, 4.63-30.30]; and HR: 6.74 [95% CI, 2.47-18.40], both p < 0.001; respectively). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 5.24 [95% CI, 2.61-14.40]; and HR: 2.98 [95% CI, 2.25-4.02]; both p < 0.001; respectively). In patients with ischemia, CMR-related coronary revascularization showed no benefit in reducing MACE (p = 0.25).
CONCLUSION
Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - J Lacotte
- Cardiovascular Institute Paris-Sud (ICPS), Department of Electrophysiology and Pacing, Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
| | - M Ait Said
- Cardiovascular Institute Paris-Sud (ICPS), Department of Electrophysiology and Pacing, Massy, France
| | - F Salerno
- Cardiovascular Institute Paris-Sud (ICPS), Department of Electrophysiology and Pacing, Massy, France
| | - L Fiorina
- Cardiovascular Institute Paris-Sud (ICPS), Department of Electrophysiology and Pacing, Massy, France
| | - V Manenti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Electrophysiology and Pacing, Massy, France
| | - J Horvilleur
- Cardiovascular Institute Paris-Sud (ICPS), Department of Electrophysiology and Pacing, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of CMR, Massy, France
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23
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Pezel T, Hovasse T, Kinnel M, Sanguineti F, Champagne S, Toupin S, Unterseeh T, Garot P, Garot J. Long-term prognostic value of stress CMR in patients with history of percutaneous coronary intervention. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Recurrence of cardiovascular (CV) events remains a substantial cause of mortality and morbidity among patients with previous coronary revascularization.
PURPOSE
The aim was to assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters and CMR-based revascularization in patients with history of percutaneous coronary intervention (PCI).
METHODS
Between 2011 and 2014, consecutive patients with history of PCI referred for stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Patients with prior coronary artery bypass graft were excluded. CMR-related coronary revascularization was defined as any revascularization occurring within 90 days after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter.
RESULTS
Of 1,762 patients who completed the CMR protocol, 1,624 patients (81.7% male, mean age 67.9 ± 10.4 years) completed the follow-up (median [interquartile range], 6.7 [5.6–7.3] years); 251 experienced a MACE (15.5%). Stress CMR was well tolerated. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 2.70 [95%CI, 2.11–3.46], p < 0.001; and HR: 1.52 [95%CI, 1.16–1.99], p = 0.002; respectively). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 2.83 [95%CI, 2.20–3.64]; p < 0.001; and HR: 1.42 [95%CI, 1.06–1.91]; p = 0.012; respectively). CMR-related coronary revascularization was associated with a lower incidence of MACE, even after adjustment.
CONCLUSIONS
Stress CMR and CMR-related revascularization were independently associated with MACE in patients with history of PCI.
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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Pezel T, Hovasse T, Kinnel M, Sanguineti F, Toupin S, Garot P, Garot J. Long-term prognostic value of stress CMR in patients with history of percutaneous coronary intervention. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Pezel T, Unterseeh T, Garot P, Hovasse T, Sanguineti F, Toupin S, Morisset S, Champagne S, Garot J. Long-term prognostic value of stress CMR-related coronary revascularization to predict death: A large registry with > 200,000 patient-years of follow-up. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Le Ven F, Dacher JN, Pontana F, Barone-Rochette G, Macron L, Garot J, Genée O, Mandry D, Christiaens LP, Gilard M, Boyer L, Furber A, Jacquier A. Position paper on stress cardiac magnetic resonance imaging in chronic coronary syndrome: Endorsed by the Société française de radiologie (SFR), the Société française d'imagerie cardiovasculaire (SFICV) and the Société française de cardiologie (SFC). Arch Cardiovasc Dis 2021; 114:325-335. [PMID: 33888446 DOI: 10.1016/j.acvd.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 12/20/2022]
Abstract
This paper is intended to update the former consensus between the French Societies of Radiology and Cardiology about the use of stress cardiac magnetic resonance imaging in chronic coronary syndrome, published in 2009. The Delphi method was used to build the present consensus. This expert panel consensus includes recommendations for indications, the procedure (with patient preparation), stress-inducing drugs, the acquisition protocol, interpretation and risk stratification by stress magnetic resonance imaging.
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Affiliation(s)
- Florent Le Ven
- Department of Cardiology, Brest University Hospital, EA3878GETBO, Université de Bretagne Occidentale, 29609 Brest, France.
| | - Jean-Nicolas Dacher
- Normandy University, UNIROUEN, INSERM U1096, Department of Medical Imaging, Cardiac Imaging Unit, Rouen University Hospital, 76000 Rouen, France
| | - François Pontana
- Université de Lille, U1011-EGID, 59045 Lille, France; INSERM U1011, 59019 Lille, France; Institut Pasteur de Lille, 59000 Lille, France; Department of Cardiovascular Radiology, CHU de Lille, 59000 Lille, France
| | - Gilles Barone-Rochette
- Department of Cardiology, CHU Grenoble Alpes, 38700 La Tronche, France; Radiopharmaceutiques Biocliniques, INSERM U1039, Grenoble Alpes University, 38700 La Tronche, France; French Alliance Clinical Trial, French Clinical Research Infrastructure Network, 75018 Paris, France
| | - Laurent Macron
- Department of Imaging, Centre Cardiologique du Nord de Saint-Denis, 93200 Saint-Denis, France
| | - Jerome Garot
- Cardiac MRI-Institut Cardiovasculaire Paris Sud, Jacques-Cartier Private Hospital-Ramsay Health, 91300 Massy, France
| | - Olivier Genée
- Pôle Santé Oréliance, Centre Cardiologique d'Orléans, 45770 Saran, France
| | - Damien Mandry
- Lorraine University, IADI, INSERM U1254, 54000 Nancy, France; Department of Radiology, Brabois, CHRU Nancy, 54000 Nancy, France
| | | | - Martine Gilard
- Department of Cardiology, Brest University Hospital, EA 4324 ORPHY, Université de Bretagne Occidentale, 29609 Brest, France
| | - Louis Boyer
- Pôle Imagerie Diagnostique et Radiologie Interventionnelle, CHU Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - Alain Furber
- Institut MITOVASC, UMR INSERM U1083, CNRS 6015, Équipe Physiopathologie Cardiovasculaire, Service de Cardiologie, CHU d'Angers, Université d'Angers, 49000 Angers, France
| | - Alexis Jacquier
- Aix-Marseille Université, Department of Radiology and Cardiovascular Imaging, Hôpital Timone, AP-HM, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), 13385 Marseille, France
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Pezel T, Garot P, Kinnel M, Landon V, Hovasse T, Sanguineti F, Champagne S, Unterseeh T, Louvard Y, Morice MC, Garot J. Feasibility and prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Several studies have demonstrated the consistently high diagnostic and prognostic value of stress perfusion imaging with cardiovascular magnetic resonance (CMR). The feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation (AF) is unknown, because most studies have excluded arrhythmic patients from analysis.
PURPOSE
The aim of our study was to assess the technical feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF.
METHODS
Between 2008 and 2018, we prospectively included consecutive patients with AF referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction (MI). The secondary outcome was all-cause mortality. The diagnosis of AF was confirmed on 12-lead ECG before and after CMR, and patients with sinus rhythm during CMR were excluded. In the CMR protocol, to limit AF-related artifacts on cine images, an arrhythmia rejection algorithm, or real-time sequences were used. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.
RESULTS
Of 639 patients with AF and suspected or stable chronic CAD (72 ± 9 years, 77% men), 602 (94%) completed the CMR protocol, and among those 538 (89%) completed the follow-up (median follow-up 5.1 (3.3–7.1) years). Reasons for failure to complete CMR included AF-related ECG-gating problems (n = 17), intolerance to stress agent (n = 7), renal failure (n = 6), declining participation (n = 4) and claustrophobia (n = 3).
Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.2%) than those with ischemia and without LGE (8.9%), or those with both ischemia and LGE (9.8%; p < 0.001 for all). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 7.56 ; 95% confidence interval CI: 4.86 – 11.80; p < 0.001) (Figure).
In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 5.88 ; 95% CI: 3.70 - 10.07; p < 0.001) and all-cause mortality (HR 2.51 ; 95% CI: 1.47 - 4.17; p < 0.001).
CONCLUSION
Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE and all-cause mortality in patients with AF.
Abstract Figure. Kaplan-Meier curves for MACE
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - V Landon
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - MC Morice
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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Pezel T, Garot P, Kinnel M, Landon V, Hovasse T, Toupin S, Unterseeh T, Morice MC, Champagne S, Louvard Y, Sanguineti F, Garot J. Prognostic value of vasodilator stress perfusion CMR in patients with known myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Several studies have demonstrated the consistently high prognostic value of stress perfusion cardiovascular magnetic resonance (CMR). This prognostic value in patients with known myocardial infarction (MI) is poorly described. There remains some skepticism about the capacity of stress CMR in predicting the clinical outcome due to the technical challenge during image analysis causes by myocardial scar.
PURPOSE
The aim of our study was to assess the prognostic value of vasodilator stress perfusion CMR in patients with known MI.
METHODS
We prospectively included consecutive patients with known MI referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.
RESULTS
Of 1602 patients with known MI (68 ± 17 years, 78% men), 1556 (97%) completed the CMR protocol, and among those 1401 (90%) completed the follow-up (median follow-up 5.7 (3.9–7.6) years). Reasons for failure to complete CMR included ECG-gating problems (n = 13), intolerance to stress agent (n = 12), renal failure (n = 12), declining participation (n = 4) and claustrophobia (n = 5). Stress CMR was well tolerated without occurrence of death or severe adverse event. Patients without inducible ischemia experienced a substantially lower annual event rate of MACE (3.1%) than those with 1 or 2 segments of ischemia (4.5%), than those with 3 to 5 segments of ischemia (21.5%), than those with 6 or more segments of ischemia (45.7%, for all p < 0.01). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 3.52; 95% confidence interval CI: 2.67 – 4.65; p < 0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 2.84; 95% CI: 2.14 to 3.78; p < 0.001).
CONCLUSION
Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE in patients with known MI.
Abstract Figure. Kaplan-Meier curves for MACE
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - V Landon
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - MC Morice
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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Pezel T, Sanguineti F, Kinnel M, Landon V, Garot P, Hovasse T, Unterseeh T, Champagne S, Louvard Y, Morice MC, Garot J. Stress perfusion CMR provides strong long-term prognostic value to cardiac events irrespective of patient sex. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men due to a lack of early diagnosis and management. Numerous clinical studies have shown that stress cardiovascular magnetic resonance (CMR) detects evidence of myocardial ischemia and infarction at high accuracy. However, long-term prognosis data are limited.
PURPOSE
The aim of this study was to test the hypothesis that stress perfusion CMR imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men.
METHODS
Consecutive patients referred for vasodilator stress perfusion CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. The safety of the CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR in each sex.
RESULTS
Of 3436 patients referred for stress CMR in a single French center, 3322 (97%) completed the CMR protocol (59.9 ± 11.8 years, 57% men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4 ± 0.2 years). Reasons for failure to complete CMR included renal failure (n = 29), claustrophobia (n = 26), poor gating (n = 22), intolerance to stress agent (n = 19) and declining participation (n = 18).
Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of inducible myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36 ; 95% confidence interval CI: 1.54–3.62; p < 0.001) and men (HR 3.57 ; 95% confidence interval CI: 2.75 – 4.64; p < 0.001) (Figure). Moreover, inducible ischemia was associated with cardiovascular death for both women (hazard ratio HR 1.92; 95% confidence interval CI: 1.12 – 2.74; p = 0.04) and men (HR 2.71 ; 95% confidence interval CI: 1.98 – 4.41; p < 0.001).
In a multivariable stepwise Cox regression including clinical characteristics and CMR, presence of inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85 ; 95% confidence interval CI: 1.18 – 2.92; p = 0.008) and men (HR 3.55 ; 95% confidence interval CI: 2.73 – 4.63; p < 0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65 – 3.01; p < 0.01) but not for women (p = 0.11).
CONCLUSION
Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients of either sex presenting with inducible ischemia. However, inducible ischemia is an independent predictor of a higher incidence of CV mortality only in men.
Abstract Figure.
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - V Landon
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - MC Morice
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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30
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Pezel T, Bonnet G, Garot P, Asselin A, Unterseeh T, Champagne S, Hovasse T, Kinnel M, Sanguineti F, Garot J. Additional prognostic value of vasodilator stress CMR in patients with inconclusive stress test to detect coronary artery disease. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Guidelines recommend performing a non-invasive testing for ischemia to diagnose coronary artery disease (CAD). However, these tests are frequently inconclusive (25%). This population has been poorly studied because of its heterogeneity. In such cases, stress cardiac magnetic resonance (CMR) may be useful to improve diagnostic certainty. To date, no study has evaluated the prognostic value of stress CMR in these patients presenting with prior inconclusive test.
PURPOSE
To assess the additional prognostic value of vasodilator stress perfusion CMR in patients with a first inconclusive stress test to detect CAD.
METHODS
Between 2008 and 2018, consecutive patients with inconclusive stress test prospectively referred for vasodilator stress perfusion CMR with dipyridamole were followed for major adverse cardiovascular events (MACE) defined as cardiac death or myocardial infarction. Inconclusive stress test was defined by echocardiography or nuclear stress testing with uncertain conclusion about the diagnosis of CAD. To characterize this population, an unsupervised clustering analysis was performed using 18 variables. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia by stress CMR in each cluster.
RESULTS
Of 1502 patients with inconclusive stress test (62 ± 12 years, 59% men), 1441 (96%) completed the CMR protocol and 1397(93%) completed the follow-up (median 5.5 ± 2.3 years). Stress CMR was well tolerated without occurrence of death or severe adverse event. The clustering analysis identified 3 clusters:
Cluster 1 (n = 524, 35%) had the highest prevalence of previous percutaneous coronary intervention (PCI), the highest presence of myocardial scar on CMR, the lowest LVEF(35 ± 7%) and the highest degree of LV dilatation.
Cluster 2 (n = 406, 27%) had the highest prevalence of previous coronary artery bypass grafting (CABG), preserved LVEF(54 ± 10%), absence of LV dilatation and rate of male(89%).
Cluster 3 (n = 572, 38%) had the lowest rate of previous PCI/CABG and of myocardial scar. This cluster gathered the oldest patients (73 ± 11 years), predominantly female (60%), with the highest rate of atrial fibrillation and body mass index.
Survival analysis found significant differences across clusters for the occurrence of MACE (p = 0.02). Moreover, inducible ischemia was significantly associated with the occurrence of MACE in each cluster (cluster 1, HR 2.28; [95%CI: 1.31-3.99]; p = 0.0028; cluster 2, HR 3.37; [95%CI, 1.97-5.75]; p < 0.0001; cluster 3, HR 2.73; [95%CI, 1.67-4.46]; p < 0.0001). In multivariable Cox regression, inducible ischemia was an independent predictor of a higher incidence of MACE in each cluster (p < 0.001).
CONCLUSIONS
Cluster analysis identified 3 different phenotypes of patients with inconclusive stress test that were associated with distinct clinical and prognostic profiles. Within these clusters, CMR stress has an additional prognostic value to predict the occurrence of MACE.
Abstract Figure. Kaplan-Meier for MACE in each cluster
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - G Bonnet
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - A Asselin
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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Pezel T, Garot P, Hovasse T, Toupin S, Unterseeh T, Morice MC, Champagne S, Louvard Y, Sanguineti F, Garot J. Vasodilatation stress cardiovascular magnetic resonance: feasibility and safety in a monocentric prospective study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Cardiovascular magnetic resonance imaging (CMR) has emerged as an accurate technique that can assess ventricular function, stress myocardial perfusion, and viability, without radiation. Recent studies have shown that stress CMR would be the best test to predict obstructive coronary artery disease (CAD) with a good safety.
PURPOSE
The aim of our study was to assess the feasibility and incidence of immediate complications of stress CMR in a tertiary Cardiovascular Center with CMR Laboratory dedicated.
METHODS
Prospective registry of vasodilator stress CMR in a French center with CMR expertise included all consecutive patients referred for vasodilator stress perfusion CMR to detect an obstructive CAD between 2008 and 2020. Stress CMR was performed at 1.5 T using dipyridamole. The clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications were prospectively recorded.
RESULTS
Stress CMR was performed in 35,157 patients (98.2% of requested). The study could not be performed due to claustrophobia in 0.3%. Quality was optimal in 93.1%, suboptimal in 6.4%, and poor in 0.5% of studies. Images were diagnostic in 97.9% of patients. No patient died or had acute myocardial infarction during the test. Moreover, 56 patients (0.16%) had severe immediate complications, and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia (p < 0.001). Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (35.5%).
CONCLUSION
Performance of stress CMR is safe with very high image rate of satisfactory quality to perform the diagnosis in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications.
Abstract Table. Final results after stress CMR
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Toupin
- Siemens Healthcare France , MRI Department , Saint Denis, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - MC Morice
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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Georgiopoulos G, Figliozzi S, Sanguineti F, Aquaro GD, di Bella G, Stamatelopoulos K, Chiribiri A, Garot J, Masci PG, Ismail TF. Prognostic Impact of Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance in Myocarditis: A Systematic Review and Meta-Analysis. Circ Cardiovasc Imaging 2021; 14:e011492. [PMID: 33441003 DOI: 10.1161/circimaging.120.011492] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patients with acute myocarditis (AM) are at increased risk of adverse cardiac events after the index episode. Late gadolinium enhancement (LGE) detected by cardiovascular magnetic resonance in patients with AM plays an important diagnostic role, but its prognostic significance remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of cardiovascular magnetic resonance-derived LGE in patients with AM. METHODS Data search was conducted from inception through February 28, 2020, using the following Medical Subject Heading terms: Myocarditis, CMR, Magnetic Resonance Imaging, Magnetic Resonance. From 2422 articles retrieved, we selected 11 studies reporting baseline cardiovascular magnetic resonance assessment and long-term clinical follow-up in patients with AM. Hazard ratios and CIs for a combined clinical end point were recorded for LGE presence, extent (>2 segments or >10% of left ventricular [LV] mass or >17g) and location (anteroseptal versus non-anteroseptal). A combined end point comprised all-cause mortality, cardiac mortality, and major adverse cardiovascular events. Hartung and Knapp correction improved robustness of the results. Prespecified sensitivity analyses explored potential sources of heterogeneity. The meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. RESULTS LGE presence (pooled hazard ratios, 3.28 [95% CIs, 1.69-6.39], P<0.001 [95% CIs, 1.33-8.11] after Hartung and Knapp correction) and anteroseptal LGE (pooled-hazard ratios, 2.58 [95% CIs, 1.87-3.55], P<0.001 [95% CIs, 1.64-4.06] after Hartung and Knapp correction) were associated with an increased risk of the combined end point. Extensive LGE was associated with worse outcomes (pooled-hazard ratios, 1.96 [95% CIs, 1.08-3.56], P=0.027), but this association was not confirmed after Hartung and Knapp correction (95% CIs, 0.843-4.57). CONCLUSIONS LGE presence and anteroseptal location at baseline cardiovascular magnetic resonance are important independent prognostic markers that herald an increased risk of adverse cardiac outcomes in patients with AM. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42019146619.
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Affiliation(s)
- Georgios Georgiopoulos
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom (G.G., S.F., A.C., P.G.M., T.F.I.).,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece (G.G., K.S.)
| | - Stefano Figliozzi
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom (G.G., S.F., A.C., P.G.M., T.F.I.)
| | - Francesca Sanguineti
- Cardiovascular MR Lab, ICPS, Hôpital Privé Jacques Cartier-Ramsay Santé, Massy, France (F.S., J.G.)
| | | | - Gianluca di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy (G.d.B.)
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece (G.G., K.S.)
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom (G.G., S.F., A.C., P.G.M., T.F.I.)
| | - Jerome Garot
- Cardiovascular MR Lab, ICPS, Hôpital Privé Jacques Cartier-Ramsay Santé, Massy, France (F.S., J.G.)
| | - Pier Giorgio Masci
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom (G.G., S.F., A.C., P.G.M., T.F.I.)
| | - Tevfik F Ismail
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom (G.G., S.F., A.C., P.G.M., T.F.I.)
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Pezel T, Sanguineti F, Hovasse T, Unterseeh T, Morice M, Toupin S, Louvard Y, Champagne S, Garot P, Garot J. Vasodilator perfusion stress cardiovascular magnetic resonance: Feasibility and safety in a French monocentric prospective study. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pezel T, Garot P, Kinnel M, Landon V, Hovasse T, Morice M, Unterseeh T, Champagne S, Louvard Y, Sanguineti F, Garot J. Stress Perfusion Cardiovascular Magnetic Resonance (CMR) Provides Strong Long-term Prognostic Value to Cardiac Events Irrespective of Patient Sex. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pezel T, Garot P, Kinnel M, Landon V, Hovasse T, Toupin S, Unterseeh T, Morice M, Champagne S, Louvard Y, Sanguineti F, Garot J. Prognostic value of vasodilator stress perfusion CMR in patients with known myocardial infarction. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kinnel M, Garot J, Pezel T, Unterseeh T, Hovasse T, Champagne S, Landon V, Morice M, Garot P, Louvard Y, Sanguineti F. Prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in patients with previous coronary artery bypass graft (CABG). Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Prouknitzky J, Garot J, Legrand L, Bordet C, Ader F, Richard P, Charron P. Report of a new case of saw-tooth cardiomyopathy: Clinical presentation and genetic analysis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pezel T, Bonnet G, Garot P, Asselin A, Unterseeh T, Champagne S, Hovasse T, Kinnel M, Sanguineti F, Garot J. Additional prognostic value of vasodilator stress CMR in patients with inconclusive stress test to detect coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Guidelines recommend performing a non-invasive testing for ischemia to diagnose coronary artery disease (CAD). However, these tests are frequently inconclusive (25%). This population has been poorly studied because of its heterogeneity. In such cases, stress cardiac magnetic resonance (CMR) may be useful to improve diagnostic certainty. To date, no study has evaluated the prognostic value of stress CMR in these patients presenting with prior inconclusive test.
Purpose
To assess the additional prognostic value of vasodilator stress perfusion CMR in patients with a first inconclusive stress test to detect CAD.
Material
Between 2008 and 2018, consecutive patients with inconclusive stress test prospectively referred for vasodilator stress perfusion CMR with dipyridamole were followed for major adverse cardiovascular events (MACE) defined as cardiac death or myocardial infarction. Inconclusive stress test was defined by echocardiography or nuclear stress testing with uncertain conclusion about the diagnosis of CAD. To characterize this population, an unsupervised clustering analysis was performed using 18 variables. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia by stress CMR in each cluster.
Results
Of 1502 patients with inconclusive stress test (62±12 years, 59% men), 1441 (96%) completed the CMR protocol and 1397 (93%) completed the follow-up (median 5.5±2.3 years). Stress CMR was well tolerated without occurrence of death or severe adverse event. The clustering analysis identified 3 clusters:
Cluster 1 (n=524, 35%) had the highest prevalence of previous percutaneous coronary intervention (PCI), the highest presence of myocardial scar on CMR, the lowest LVEF (35±7%) and the highest degree of LV dilatation.
Cluster 2 (n=406, 27%) had the highest prevalence of previous coronary artery bypass grafting (CABG), preserved LVEF (54±10%), absence of LV dilatation and rate of male (89%).
Cluster 3 (n=572, 38%) had the lowest rate of previous PCI/CABG and of myocardial scar. This cluster gathered the oldest patients (73±11 years), predominantly female (60%), with the highest rate of atrial fibrillation and body mass index.
Survival analysis found significant differences across clusters for the occurrence of MACE (p=0.02). Moreover, inducible ischemia was significantly associated with the occurrence of MACE in each cluster (cluster 1, HR 2.28; [95% CI: 1.31–3.99]; p=0.0028; cluster 2, HR 3.37; [95% CI, 1.97–5.75]; p<0.0001; cluster 3, HR 2.73; [95% CI, 1.67–4.46]; p<0.0001). In multivariable Cox regression, inducible ischemia was an independent predictor of a higher incidence of MACE in each cluster (p<0.001).
Conclusions
Cluster analysis identified 3 different phenotypes of patients with inconclusive stress test that were associated with distinct clinical and prognostic profiles. Within these clusters, CMR stress has an additional prognostic value to predict the occurrence of MACE.
Kaplan-Meier for MACE in each cluster
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Pezel
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - G Bonnet
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - A Asselin
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
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Pezel T, Sanguineti F, Kinnel M, Bonnet G, Landon V, Hovasse T, Garot P, Unterseeh T, Champagne S, Louvard Y, Morice M, Garot J. Feasibility and prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Several studies have demonstrated the consistently high diagnostic and prognostic value of stress perfusion imaging with cardiovascular magnetic resonance (CMR). The feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation (AF) is unknown, because most studies have excluded arrhythmic patients from analysis.
Purpose
The aim of our study was to assess the technical feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF.
Material
Between 2008 and 2018, we prospectively included consecutive patients with AF referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction (MI). The secondary outcome was all-cause mortality. The diagnosis of AF was confirmed on 12-lead ECG before and after CMR, and patients with sinus rhythm during CMR were excluded. In the CMR protocol, to limit AF-related artifacts on cine images, an arrhythmia rejection algorithm, or real-time sequences were used. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.
Results
Of 639 patients with AF and suspected or stable chronic CAD (72±9 years, 77% men), 602 (94%) completed the CMR protocol, and among those 538 (89%) completed the follow-up (median follow-up 5.1 (3.3–7.1) years). Reasons for failure to complete CMR included AF-related ECG-gating problems (n=17), intolerance to stress agent (n=7), renal failure (n=6), declining participation (n=4) and claustrophobia (n=3).
Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.2%) than those with ischemia and without LGE (8.9%), or those with both ischemia and LGE (9.8%; p<0.001 for all). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 7.56; 95% confidence interval CI: 4.86–11.80; p<0.001) (Figure).
In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 5.88; 95% CI: 3.70–10.07; p<0.001) and all-cause mortality (HR 2.51; 95% CI: 1.47–4.17; p<0.001).
Conclusion
Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE and all-cause mortality in patients with AF.
Kaplan-Meier curves for MACE
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - G Bonnet
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Ce, Paris, France
| | - V Landon
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M.C Morice
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
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Pezel T, Kinnel M, Sanguineti F, Garot P, Hovasse T, Landon V, Unterseeh T, Champagne S, Louvard Y, Morice M, Garot J. Prognostic value of vasodilator stress perfusion CMR in patients with previous coronary artery bypass graft (CABG). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The accuracy and prognostic value of stress perfusion cardiac magnetic resonance (CMR) are well established in patients with suspected or proven coronary artery disease (CAD). Because myocardial contrast kinetics may be altered in patients with previous coronary artery bypass graft (CABG), most studies have excluded those patients in whom prognostic data are missing.
Purpose
To assess the safety and prognostic value of vasodilator stress perfusion CMR in patients with previous CABG.
Material
Between 2008 and 2018, we prospectively included consecutive patients with CABG referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined by cardiovascular death, nonfatal myocardial infarction or late coronary revascularization (>90 days after CMR). The safety of the stress perfusion CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic association of inducible ischemia and late gadolinium enhancement (LGE) on CMR.
Results
Of 866 CABG patients (70±9 years, 89% men), 852 (98%) completed the CMR protocol and 771 (89%) completed the follow-up (median 4.2±2.7 years). Reasons for failure to complete CMR included renal failure (n=4), intolerance to stress agent (n=4), claustrophobia (n=2), poor gating (n=2) and declining participation (n=2).
Stress CMR was well tolerated without occurrence of death or severe adverse event. In this cohort, 531 (61%) patients had a myocardial infarction defined by the presence of LGE with ischemic patterns in CMR. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (12.8%) than those with ischemia and without LGE (27.6%), or those with both ischemia and LGE (28.2%; p<0.001 for all). Using Kaplan-Meier analyses, the presence of myocardial ischemia was correlated with the occurrence of MACE and cardiac mortality (both p<0.0001) (Figure). In multivariable stepwise Cox regression, the absence of inducible ischemia was an independent predictor of a lower incidence of MACE (HR 2.17, 95% CI 1.56–3.13; p<0.001) and cardiovascular mortality (HR 2.38; 95% CI 1.39 0.25–4.03; p=0.001).
Conclusions
Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE and cardiovascular mortality in patients with CABG.
Kaplan-Meier: MACE (A) – CV Mortality (B)
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Pezel
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - V Landon
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M.C Morice
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
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Pezel T, Sanguineti F, Kinnel M, Landon V, Garot P, Hovasse T, Unterseeh T, Champagne S, Louvard Y, Morice M, Garot J. Stress perfusion CMR provides strong long-term prognostic value to cardiac events irrespective of patient sex. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men due to a lack of early diagnosis and management. Numerous clinical studies have shown that stress cardiovascular magnetic resonance (CMR) detects evidence of myocardial ischemia and infarction at high accuracy. However, long-term prognosis data are limited.
Purpose
The aim of this study was to test the hypothesis that stress perfusion CMR imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men.
Material
Consecutive patients referred for vasodilator stress perfusion CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. The safety of the CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR in each sex.
Results
Of 3436 patients referred for stress CMR in a single French center, 3322 (97%) completed the CMR protocol (59.9±11.8 years, 57% men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4±0.2 years). Reasons for failure to complete CMR included renal failure (n=29), claustrophobia (n=26), poor gating (n=22), intolerance to stress agent (n=19) and declining participation (n=18).
Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of inducible myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36; 95% confidence interval CI: 1.54–3.62; p<0.001) and men (HR 3.57; 95% confidence interval CI: 2.75–4.64; p<0.001) (Figure). Moreover, inducible ischemia was associated with cardiovascular death for both women (hazard ratio HR 1.92; 95% confidence interval CI: 1.12–2.74; p=0.04) and men (HR 2.71; 95% confidence interval CI: 1.98–4.41; p<0.001).
In a multivariable stepwise Cox regression including clinical characteristics and CMR, presence of inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85; 95% confidence interval CI: 1.18–2.92; p=0.008) and men (HR 3.55; 95% confidence interval CI: 2.73–4.63; p<0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65–3.01; p<0.01) but not for women (p=0.11).
Conclusion
Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients of either sex presenting with inducible ischemia. However, inducible ischemia is an independent predictor of a higher incidence of CV mortality only in men.
Kaplan-Meier curves for MACE in each sex
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Pezel
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - V Landon
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Hovasse
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M.C Morice
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
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Pezel T, Sanguineti F, Kinnel M, Landon V, Garot P, Hovasse T, Unterseeh T, Champagne S, Louvard Y, Morice M, Garot J. Safety and prognostic value of vasodilator stress CMR in patients with heart failure and reduced ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent data suggest that patients with HFrEF (heart failure with reduced left ventricular ejection fraction (LVEF) <40%) referred for stress cardiovascular magnetic resonance (CMR) may have a less optimal haemodynamic response to intravenous vasodilator. The prognostic value of stress CMR has been poorly investigated in this population.
Purpose
To assess the safety and the prognostic value of vasodilator stress perfusion CMR in patients with HFrEF.
Material
Between 2008 and 2018, we prospectively included consecutive patients with HFrEF referred for vasodilator stress perfusion CMR with dipyridamole. HFrEF was defined by a previous history of HF and known LVEF <40%. All patients with LVEF ≥40% measured by CMR were excluded.
They were followed for the occurrence of major adverse cardiovascular events (MACE) defined by cardiovascular death or nonfatal myocardial infarction (MI). The secondary endpoint was a composite outcome of cardiovascular death or rehospitalization for acute HF defined by the use of intravenous diuretics. The safety of the stress perfusion CMR was assessed by clinical monitoring for 1 hour after the end of the CMR.
Univariable and multivariable Cox regressions were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR.
Results
Of 1084 patients with HFrEF (65±11 years, median LVEF 34.6±4.9%), 1049 (97%) completed the CMR protocol and among those 952 (91%) completed the follow-up (median 5.6±2.4 years). Reasons for failure to complete CMR included declining participation (n=11), renal failure (n=9), intolerance to stress agent (n=8), claustrophobia (n=4) and poor gating (n=3).
Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Among patients who underwent CMR, 600 (57%) were diagnosed with MI defined by LGE. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.8%) than those with ischemia and without LGE (9.4%), or those with both ischemia and LGE (12.0%; p<0.001 for all). Using Kaplan-Meier analysis, the presence of inducible ischemia and LGE were significantly associated with the occurrence of MACE (hazard ratio [HR], 2.46 [95% CI, 1.69–3.59]; p<0.001) (Figure). In multivariable stepwise Cox regression including clinical characteristics and CMR, the inducible ischemia was an independent predictor of a higher incidence of MACE at follow-up (adjusted HR, 2.26 [95% CI, 1.52–3.35]; p<0.001). However, there was no significant difference between patients with or without ischemia for the secondary outcome (p=0.28).
Conclusions
Stress CMR is safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients with HFrEF.
Kaplan-Meier curves for MACE
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Pezel
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - F Sanguineti
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - M Kinnel
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - V Landon
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - P Garot
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - T Hovasse
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - Y Louvard
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - M.C Morice
- Institut Cardiovasculaire Paris Sud, Paris, France
| | - J Garot
- Institut Cardiovasculaire Paris Sud, Paris, France
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Sanguineti F, Garot J, Hovasse T, Unterseeh T, Champagne S, Garot P. [IRM et myocardite infectieuse]. Ann Cardiol Angeiol (Paris) 2020; 69:418-423. [PMID: 33069385 PMCID: PMC7556279 DOI: 10.1016/j.ancard.2020.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/21/2022]
Abstract
Au cours des dix dernières années, l’IRM cardiaque est devenue un outil incontournable pour le diagnostic de myocardite aiguë. Elle peut, sous certaines conditions, permettre de surseoir à la coronarographie initiale dans de nombreuses situations. Son utilisation est préconisée en classe I, dans la situation du MINOCA, dans les recommandations de l’ESC de septembre 2020, pour permettre d’établir un diagnostic de certitude entre infarctus aigu, myocardite, Tako-Tsubo, ou autres cardiopathies en permettant d’améliorer la prise en charge thérapeutique et le suivi. Cet article reprend les principes techniques de l’IRM dans la myocardite (critères diagnostiques de Lake Louise et critères basés sur la cartographie tissulaire myocardique), les principaux diagnostics différentiels et la valeur pronostique, ainsi que la myocardite associée au COVID-19.
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Affiliation(s)
- F Sanguineti
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - J Garot
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France.
| | - T Hovasse
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - T Unterseeh
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - S Champagne
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - P Garot
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
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Pezel T, Viallon M, Croisille P, Sebbag L, Bochaton T, Garot J, Lima JAC, Mewton N. Imaging Interstitial Fibrosis, Left Ventricular Remodeling, and Function in Stage A and B Heart Failure. JACC Cardiovasc Imaging 2020; 14:1038-1052. [PMID: 32828781 DOI: 10.1016/j.jcmg.2020.05.036] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
Myocardial interstitial fibrosis is part of the advanced disease stage of most cardiovascular pathologies. It has been characterized histologically in various disease settings from hypertensive heart disease and diabetic cardiomyopathy to severe aortic stenosis. It is also involved in the process of aging. In cardiovascular medicine, myocardial interstitial fibrosis is associated with several adverse outcomes, especially heart failure (HF) and sudden cardiac death. Until recently, clinical measures of interstitial fibrosis could only be made by invasive myocardial biopsy. The availability of cardiac magnetic resonance (CMR) T1 mapping techniques allows for the indirect measurement of interstitial space characteristics and extracellular volume size, which is closely correlated with collagen content and interstitial infiltration by amyloid and other molecules. There has been significant improvement in the accuracy and reproducibility of T1 acquisition sequences in the last decade; however, the correct use of this technique requires a solid CMR expertise in daily imaging practice. CMR has become the gold standard to assess left ventricular (LV) remodeling and functional features associated with interstitial fibrosis. These features can be detected in the early stages of HF. The main objective of this paper is to review the relevant results of preclinical and clinical observational studies that demonstrate the prognostic impact of interstitial fibrosis assessed by T1 mapping, as well as adverse left ventricular remodeling, as determinants of HF. Therefore, this review focuses on the pathological mechanisms underlying LV remodeling and interstitial fibrosis, in addition to the technical considerations involved in the assessment of interstitial LV fibrosis by CMR. It provides a thorough review of clinical evidence that demonstrates the association of interstitial fibrosis and other-CMR derived LV phenotypes with Stages A and B HF.
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Affiliation(s)
- Theo Pezel
- Department of Cardiology, Paris University, Lariboisiere Hospital, AP-HP, INSERM, UMRS 942, Paris, France; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Magalie Viallon
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Pierre Croisille
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Laurent Sebbag
- Heart Failure and Transplant Department, Hospices Civils de Lyon, Hôpital Louis Pradel, Bron, France
| | - Thomas Bochaton
- Hospices Civils de Lyon, Hôpital Louis Pradel, Cardiac Intensive Care Unit, Bron, France
| | - Jerome Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay-Générale de Santé, Massy, France
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Nathan Mewton
- Cardiovascular Hospital Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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Kinnel M, Pezel T, Hovasse T, Garot P, Unterseeh T, Champagne S, Morice M, Louvard Y, Garot J, Sanguineti F. Vasodilator stress perfusion CMR is feasible and has prognostic value in morbid obese patients without known CAD. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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46
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Pezel T, Kinnel M, Garot P, Unterseeh T, Champagne S, Louvard Y, Morice M, Sanguineti F, Garot J. Feasibility and prognostic value of vasodilator stress perfusion Cardiac Magnetic Resonance in elderly patients > 75 years without known CAD. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Sanguineti F, Garot P, Hovasse T, Unterseeh T, Troussier X, Dinan-Magniez A, Garot J. P5275Cardiovascular magnetic resonance predictors of long term clinical outcome in myocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are still debated. The study objectives were to determine the potential value of cardiovascular magnetic resonance (CMR) parameters for the long-term Major Adverse Cardiac Events (MACE) prediction in patients presenting with suspected AM. In our centre we published in 2015 a first analysis of the CMR myocarditis registry which included patients presenting with suspected AM in routine practice, clinically followed-up for 18 months (median follow up). This first analysis, in disagreement with the published data, did not find CMR predictors of MACE except for the LVEF.
Purpose
As in myocarditis MACE could have a gradual evolution, to confirm our initial results, the aim of this study is to reinvestigate in the same population, the potential value of CMR parameters with a longer follow-UP (median 8.34 years, interquartile range: 7.7 to 9.16 years).
Methods
In a single-centre longitudinal prospective study, 203 routine consecutive patients with clinical suspicion of AM and initial CMR-based diagnosis of AM (typical Late Gadolinium Enhancement, LGE) were clinically followed up. Various CMR parameters were evaluated as potential predictors of outcome. The primary endpoint was defined as the occurrence of at least one of the combined MACE: cardiac death or aborted sudden cardiac death, cardiac transplantation, sustained documented ventricular tachycardia, heart failure, recurrence of acute myocarditis, and the need for hospitalization for cardiac causes.
Results
The vast majority of patients (70,44%; N=143) presented with chest pain, mild to moderate troponin elevation and ST-segment or T wave abnormalities. Various CMR parameters were evaluated on initial CMR performed 3±2 days after acute clinical presentation (LV functional parameters, presence/extent of edema on T2, presence/extent of Early Gadolinium Enhancement (EGA) and extent of late gadolinium enhancement lesions). Out of the 203 patients, 35 (17.2%) experienced at least one major cardiovascular event during follow-up. Among all CMR parameters, initial alteration of LVEF was confirmed a MACE independent predictor by multivariate analysis (HR: 1.03 per 10% decrease, 95% CI: 1.01 to 1.06, p=0.04). Furthermore, at longer FU analysis, absence of EGA predicted adverse clinical outcome (HR: 2.7, 95% CI: 1.12 to 6.27, p=0.02) suggesting a potential protecting role of inflammatory response.
Conclusions
In routine clinical practice, in patients without severe hemodynamic compromise and a CMR-based diagnosis of AM, various CMR parameters such as the presence, extent and myocardial localisation of late gadolinium-enhanced LV myocardial lesions, were not predictive of events at long term follow up. CMR predictor of adverse clinical outcome were an initial alteration of LVEF and the absence of EGA.
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Affiliation(s)
- F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - X Troussier
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | | | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
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Kinnel M, Pezel T, Hovasse T, Garot P, Unterseeh T, Champagne S, Louvard Y, Morice MC, Garot J, Sanguineti F. P5256Vasodilator stress perfusion CMR is feasible and has prognostic value in morbid obese patients without known CAD. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Obesity is a growing public health problem. Given the impact of obesity on cardiovascular disease, methods to effectively risk stratify obese patients are needed. Current methods for the detection of myocardial ischemia by single photon emission computed tomography or stress echocardiography remain limited in obese patients. Stress cardiac magnetic resonance (CMR) may be a powerful alternative, but its feasibility and prognostic value in the obese population has not been specifically evaluated.
Objectives
This study sought to determine feasibility and prognostic value of vasodilator stress perfusion CMR in morbid obese patients with body mass index (BMI) ≥40 kg/m2.
Methods
Consecutive patients with a BMI ≥40 kg/m2 and without known coronary artery disease (CAD) referred for vasodilating stress CMR were followed for major adverse cardiovascular events (MACE), defined as cardiac death, non-fatal myocardial infarction or stroke. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR.
Results
Of 452 obese patients, 444 (98%) completed the CMR protocol with good diagnostic imaging quality; among those, 404 (91%) completed the follow-up (mean 5.6±2.2 years). Participants averaged 59±11 years in age with 44% of men (mean BMI 43.9±3.8 kg/m2, maximum weight 210 kg and maximum BMI 67.1 kg/m2). Stress CMR was well tolerated without severe adverse event. Reasons for failure to complete CMR included claustrophobia (n=3), declining participation (n=4) and intolerance to stress agent (n=1). Patients without inducible ischemia or LGE experienced a substantially lower annual rate of MACE (3.3% vs. 12.4% for those with ischemia and vs. 11.2% for those with ischemia and LGE). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the absence of inducible ischemia was independently associated with a lower incidence of MACE at follow-up (hazard ratio 0.20; 95% confidence interval: 0.11 to 0.36; p<0.001) (Figure) and cardiac death (hazard ratio 0,11 95% confidence interval: 0.02 to 0.63; p=0,013); cardiac death was reduced in the group with no late gadolinium enhancement (hazard ratio 0,12 95% confidence interval: 0.02 to 0.66; p<0.015).
When patients with early coronary revascularization (within 30 days of CMR) were censored on the day of revascularization, both presence of inducible ischemia and ischemia extent per segment maintained a strong association with MACE. Using
Kaplan-Meier analyses, myocardial ischemia identified future CV events/survival (p<0.001), and this finding was similar in men and women (p=0.16).
Conclusion
Stress CMR is feasible and of high prognostic value in morbid obese patients, with a very low negative event rate at 5 years in patients without ischemia or infarction as opposed to patients with inducible ischemia and/or presence of myocardial infarct.
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Affiliation(s)
- M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M C Morice
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
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Pezel T, Kinnel M, Hovasse T, Garot P, Unterseeh T, Champagne S, Louvard Y, Morice MC, Sanguineti F, Garot J. P3094Feasibility and prognostic value of vasodilator stress perfusion CMR in elderly patients > 75 years without known CAD. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The World's ageing population with a life expectancy that is steadily increasing raises the question of the benefit of screening for coronary artery disease (CAD) in very old patients with high risk of CAD. Current guidelines discourage the performance of stress testing in asymptomatic elderly.
Purpose
To assess the prognostic value of vasodilator stress perfusion cardiac magnetic resonance (CMR) in elderly patients aged >75 years without previous known CAD.
Material
Consecutive elderly patients >75 years without known CAD referred for vasodilator stress perfusion CMR were followed for major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction or stroke. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR beyond traditional clinical risk indexes.
Results
Of 754 elderly high risk patients (82.0±3.9 years, 48.4% men), 747 (99%) completed the CMR protocol, and among those 659 (88.2%) completed the follow-up (median follow-up 5.7±2.5 years). Reasons for failure to complete CMR included claustrophobia (n=3), declining participation (n=2) and intolerance to stress agent (n=2). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual rate of MACE (5.5% vs. 9.9% for those with ischemia and vs. 6.9% for those with ischemia and/or LGE). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the absence of inducible ischemia was an independent predictor of a lower incidence of MACE at follow-up (hazard ratio 0.46; 95% confidence interval: 0.34 to 0.62; p<0.001) (Figure 1A) and all-cause mortality (hazard ratio 0.67; 95% confidence interval: 0.45 to 0.97; p=0.037).
When patients with early coronary revascularization (within 30 days of CMR) were censored on the day of revascularization, both presence of inducible ischemia and ischemia extent per segment maintained a strong association with MACE. Using Kaplan-Meier analyses, the presence of myocardial ischemia identified the occurrence of future CV events (p<0.001). Moreover, the absence of inducible ischemia was a predictor of a lower incidence of MACE less significant in men than in women (p<0.01) (Figure 1B).
Conclusion
Stress CMR is safe and has discriminative prognostic value in very elderly patients, with a very low negative event rate in patients without ischemia or infarction. Among elderly patients without known CAD, the presence of myocardial ischemia on vasodilator stress CMR was predictive of future CV event or death.
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Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M C Morice
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
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50
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Pezel T, Kinnel M, Hovasse T, Garot P, Unterseeh T, Champagne S, Louvard Y, Morice MC, Sanguineti F, Garot J. 271Feasibility and prognostic value of vasodilator stress perfusion CMR in elderly patients > 75 years without known CAD. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez101.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Pezel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M Kinnel
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Hovasse
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - P Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - T Unterseeh
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - S Champagne
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - Y Louvard
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - M C Morice
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - F Sanguineti
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
| | - J Garot
- Cardiovascular Institute Paris-Sud (ICPS), Department of Cardiovascular Imaging, Massy, France
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