Long-term prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance in patients with hypertension without known CVD

Abstract

Introduction

Several studies have shown the excellent prognostic value of stress cardiovascular magnetic resonance (CMR) in large cohorts of patients without known cardiovascular disease (CVD). However, its prognostic value in a dedicated cohort of patients in primary prevention with hypertension remains not well established.

Objective

The aim of our study was to assess the long-term prognostic value of vasodilator stress perfusion CMR in patients with hypertension but without known CVD.

Method

Between December 2008 and January 2022, we conducted a bi-center longitudinal study with consecutive patients with hypertension, and without a known CVD, referred for vasodilator stress perfusion CMR to the Institut cardiovasculaire Paris Sud (ICPS, Massy) and to Lariboisière University Hospital (AP–HP, Paris). All patients were followed up to the occurrence of major cardiovascular events (MACE), defined as cardiac death or non-fatal myocardial infarction (MI). Cox regressions analyses were performed to determine the prognostic value of each parameter.

Results

Among 2019 patients (mean age 68.7 ± 11.7 years; 45.4% men) with a median follow up of 6.7 years, 335 had MACE (16.6%). Patients without inducible ischaemia experienced a lower rate of MACE than those with an inducible ischaemia (12.1 versus 41.3%, respectively, p < 0.001). Using Kaplan-Meier analysis, inducible ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio [HR]: 4.39; 95% confidence interval [CI]: 3.52 to 5.47 and HR: 3.49; 95% CI: 2.76 to 4.42, respectively; both p < 0.001). Figure 1 shows Kaplan-Meier curve for MACE stratified for the presence of inducible ischaemia.

In multivariable analysis, the presence of ischaemia and LGE were independent predictors of MACE (HR: 2.91; 95% CI: 2.27 to 3.72 and HR: 2.07; 95% CI: 1.59 to 2.71, respectively; both p < 0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.06; net reclassification improvement: 0.307; integrative discrimination index: 0.071; LR test p < 0.001).

Conclusion

In patients with hypertension and without known CVD, vasodilator stress CMR has independent and incremental prognostic value to predict MACE over traditional risk factors.