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

TY - JOUR

T1 - Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis

T2 - the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) study

AU - Singh, Anvesha

AU - Greenwood, John P.

AU - Berry, Colin

AU - Dawson, Dana K.

AU - Hogrefe, Kai

AU - Kelly, Damian J.

AU - Dhakshinamurthy, Vijay

AU - Lang, Chim C.

AU - Khoo, Jeffrey P.

AU - Sprigings, David

AU - Steeds, Richard P.

AU - Jerosch-Herold, Michael

AU - Neubauer, Stefan

AU - Prendergast, Bernard

AU - Williams, Brian

AU - Zhang, Ruiqi

AU - Hudson, Ian

AU - Squire, Iain B.

AU - Ford, Ian

AU - Samani, Nilesh J.

AU - McCann, Gerry P.

N1 - The study was supported by a grant from the National Institute of Health Research (NIHRPDF 2011-04-51 Gerald P McCann) and the NIHR Leicester Cardiovascular Biomedical Research Unit, the NIHR Comprehensive Local Research Networks and the Leeds & Leicester NIHR Clinical Research Facilities. BW is supported by the NIHR UCL Hospitals Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health.

PY - 2017/4/21

Y1 - 2017/4/21

N2 - 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).

AB - 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).

KW - Aortic stenosis

KW - exercise testing

KW - magnetic resonance imaging

KW - myocardial perfusion reserve

U2 - 10.1093/eurheartj/ehx001

DO - 10.1093/eurheartj/ehx001

M3 - Article

C2 - 28204448

SN - 0195-668X

VL - 38

SP - 1222

EP - 1229

JO - European Heart Journal

JF - European Heart Journal

IS - 16

ER -