Prognostic value of stress cardiac magnetic resonance at 3 Tesla in patients with known or suspected coronary artery disease

Background

Adenosine stress cardiac magnetic resonance imaging (adenosine stress CMR) is increasingly playing a role in the non-invasive test for the diagnosis of coronary artery disease (CAD). But there are limited data on the prognostic value of predicting CAD-related death and major cardiac events (MACE) by adenosine stress CMR at 3 Tesla in Thailand.

Objectives

This study aimed to assess the prognostic value of adenosine stress CMR at 3 Tesla to predict CAD-related death, MACE, and all-cause mortality during two years in patients with known or suspected CAD.

Methods

This is a single-center retrospective cohort study in patients with suspected or known CAD who underwent adenosine stress CMR at 3 Tesla between 1 September 2017 to 31 August 2019 at our hospital. The data were collected from electronic medical record reviews. Only patients who completed two years of follow-up or had events were included in this study.

Results

A total of 633 patients were analyzed (age 66.21±12.60 years, 53.7% male, 31.9% known CAD), within two years of follow-up, we observed 15 deaths (2.4%) occurred with 5 CAD-related death (0.8%) and 10 non-fatal myocardial ischemia (non-fatal MI) (1.6%). The presence of ischemia in adenosine stress CMR at 3 Tesla is associated with CAD-related death, but the events rates of acute MI are about the same in both groups (1.4% vs. 1.7%).

Patients who underwent CAG after CMR were analyzed and categorized into normal coronary arteries, insignificant CAD, and significant CAD groups. Divided the positive adenosine stress CMR group to 6.8%, 7.7%, 85.5%, and the negative adenosine stress CMR group to 15.4%, 38.5%, 42.6%, respectively. So, the adenosine stress CMR at 3 Tesla has sensitivity at 94.34%, Specificity 29.17%, PPV 85.47%, and NPV 53.85%.

Conclusions

In this cohort study, patients with positive adenosine stress CMR were associated with an increased risk of CAD-related death. High-risk patients who received revascularization had a good prognosis as those with a negative adenosine stress perfusion CMR. Therefore, adenosine stress CMR at 3 Tesla is an effective tool with high sensitivity and positive predictive value for identifying high-risk patients for further treatment and procedures.

Funding Acknowledgement

Type of funding sources: None.

P5339Association between high-sensitive troponin I and subclinical coronary atherosclerosis in well-controlled HIV-infected adults

Background and objectives

Patients with human immunodeficiency virus (HIV) infection live longer and the prevalence of coronary heart disease is increasing among them. High-sensitive troponin I (hs-TnI) is associated with coronary artery calcification as determined by non-contrast cardiac computed tomography (CT) in general population without established cardiovascular disease (CVD). Nevertheless, the relationship in well-controlled HIV-infected patients has not been validated.

Design and methods

A cross-sectional study among HIV-infected adults aged >50 years free from known CVDs. All subjects underwent non-contrast cardiac CT and blood test for serum hs-TnI was concomitantly performed. Relationship between Agatston score, a parameter used to quantify coronary artery calcification and serum hs-TnI level was analysed using spearman correlation and logistic regression models.

Results

A total of 338 HIV-infected adults (median age 54 years, 62% men) were included. All of them were in antiretroviral therapy with a median 18 years of exposure. The median CD4 cell count was 614 cell/mm3, 98% were virologically suppressed. Hs-TnI was correlated with coronary artery calcification with the correlation coefficient of 0.287 (p<0.0001). Multivariated logistic regression analysis demonstrated that serum hs-TnI concentration was associated with an increased odd of coronary artery calcification (Agatston score>0) (OR 1.64; 95% CI, 1.05–2.56, p=0.029). To detect coronary artery calcification, using the hs-TnI in addition to Thai CV risk score slightly increased the ROCAUC from 0.6827 to 0.692 (p=0.45).

Distribution of CAC score over hs-TnI

Conclusion

Among well-controlled HIV-infected patients without established CVDs, hs-TnI concentration was associated with coronary artery calcification. This could be a potential biomarker for an early risk stratification of subclinical coronary atherosclerosis in this population. The association with long-term adverse cardiovascular outcome needs to be validated in the future study.