학술논문
Exercise ECG Testing and Stress Cardiac Magnetic Resonance for Risk Prediction in Patients With Chronic Coronary Syndrome
Document Type
Academic Journal
Author
Marcos-Garces, Victor; Merenciano-Gonzalez, Hector; Gabaldon-Perez, Ana; Nuñez-Marin, Gonzalo; Lorenzo-Hernandez, Miguel; Gavara, Jose; Perez, Nerea; Rios-Navarro, Cesar; De Dios, Elena; Bonanad, Clara; Racugno, Paolo; Lopez-Lereu, Maria Pilar; Monmeneu, Jose Vicente; Chorro, Francisco Javier; Bodi, Vicente
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Sep 22, 2021
Subject
Language
English
ISSN
1932-7501
Abstract
PURPOSE:: Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear. METHODS:: We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death. RESULTS:: During a mean follow-up of 4.2 ± 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndrome, eight admissions for heart failure, and four all-cause deaths). Once adjusted for clinical, ExECG, and VS-CMR parameters associated with SAE, the only independent predictors were HRmax in ExECG (HR = 0.98: 95% CI, 0.96-0.99; P = .01) and more extensive stress-induced perfusion defects (PDs, number of segments) in VS-CMR (HR = 1.19: 95% CI, 1.07-1.34; P < .01). Adding HRmax significantly improved the predictive power of the multivariable model for SAE, including PDs (continuous reclassification improvement index: 0.47: 95% CI, 0.10-0.81; P < .05). The annualized SAE rate was 1% (if PD < 2 segments and HRmax > 130 bpm), 2% (if PD < 2 segments and HRmax ≤ 130 bpm), 3.2% (if PD ≥ 2 segments and HRmax > 130 bpm), and 6.3% (if PD ≥ 2 segments and HRmax ≤ 130 bpm), P < .01, for the trend. In patients on β-blocker therapy, however, only PDs in VS-CMR, but not HRmax, predicted SAE. CONCLUSIONS:: We conclude that ExECG contributes significantly to prognostic information beyond VS-CMR in patients with known or suspected CCS.