Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) study

Anvesha Singh, John P. Greenwood, Colin Berry, Dana K. Dawson, Kai Hogrefe, Damian J. Kelly, Vijay Dhakshinamurthy, Chim C. Lang, Jeffrey P. Khoo, David Sprigings, Richard P. Steeds, Michael Jerosch-Herold, Stefan Neubauer, Bernard Prendergast, Brian Williams, Ruiqi Zhang, Ian Hudson, Iain B. Squire, Ian Ford, Nilesh J. SamaniGerry P. McCann

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Abstract

Aims

To assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS.
Methods and results

Multi-centre, prospective, observational study, with blinded analysis of CMR data. Patients underwent adenosine stress CMR, symptom-limited exercise testing (ETT) and echocardiography and were followed up for 12–30 months. The primary outcome was a composite of: typical AS symptoms necessitating referral for AVR, cardiovascular death and major adverse cardiovascular events. 174 patients were recruited: mean age 66.2 ± 13.34 years, 76% male, peak velocity 3.86 ± 0.56 m/s and aortic valve area index 0.57 ± 0.14 cm2/m2. A primary outcome occurred in 47 (27%) patients over a median follow-up of 374 (IQR 351–498) days. The mean MPR in those with and without a primary outcome was 2.06 ± 0.65 and 2.34 ± 0.70 (P = 0.022), while the incidence of a symptom-limited ETT was 45.7% and 27.0% (P = 0.020), respectively. MPR showed moderate association with outcome area under curve (AUC) = 0.61 (0.52–0.71, P = 0.020), as did exercise testing (AUC = 0.59 (0.51–0.68, P = 0.027), with no significant difference between the two.
Conclusions

MPR was associated with symptom-onset in initially asymptomatic patients with AS, but with moderate accuracy and was not superior to symptom-limited exercise testing. ClinicalTrials.gov (NCT01658345).
Original languageEnglish
Pages (from-to)1222-1229
Number of pages8
JournalEuropean Heart Journal
Volume38
Issue number16
Early online date13 Feb 2017
DOIs
Publication statusPublished - 21 Apr 2017

Keywords

  • Aortic stenosis
  • exercise testing
  • magnetic resonance imaging
  • myocardial perfusion reserve

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    Singh, A., Greenwood, J. P., Berry, C., Dawson, D. K., Hogrefe, K., Kelly, D. J., Dhakshinamurthy, V., Lang, C. C., Khoo, J. P., Sprigings, D., Steeds, R. P., Jerosch-Herold, M., Neubauer, S., Prendergast, B., Williams, B., Zhang, R., Hudson, I., Squire, I. B., Ford, I., ... McCann, G. P. (2017). Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) study. European Heart Journal, 38(16), 1222-1229. https://doi.org/10.1093/eurheartj/ehx001