Singh, A. et al. (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), pp. 1222-1229. (doi: 10.1093/eurheartj/ehx001) (PMID:28204448)
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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).
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Ford, Professor Ian and Berry, Professor Colin |
Authors: | 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., Samani, N. J., and McCann, G. P. |
Subjects: | R Medicine > R Medicine (General) |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
Journal Name: | European Heart Journal |
Publisher: | Oxford University Press |
ISSN: | 0195-668X |
ISSN (Online): | 1522-9645 |
Published Online: | 13 February 2017 |
Copyright Holders: | Copyright © 2017 The Authors |
First Published: | First published in European Heart Journal 38(16): 1222-1229 |
Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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