Abstract
BackgroundAortic stiffness is an independent predictor of cardiovascular (CV) events and mortality. However, no data exists for the prognosis of combined aortic stiffness and myocardial ischemia. Using cardiac magnetic resonance (CMR) imaging, we assessed the association of aortic stiffness by pulse wave velocity (PWV), myocardial ischemia, and CV events in patients with known or suspected coronary artery disease (CAD).MethodsVelocity-encoded CMR was performed in 520 patients who had undergone adenosine stress CMR. The PWV was determined between the mid-ascending and mid-descending thoracic aorta. Patients were divided into 4 groups by PWV (higher or lower PWV) and myocardial ischemia (positive or negative ischemia). Combined CV events including mortality, acute coronary syndrome, heart failure, coronary revascularization, and stroke were analyzed among the 4 groups.ResultsThe median follow-up period was 46.5 months, and the median PWV was 10.54 m/sec. Myocardial ischemia was positive in 199 patients (38.3%). The group with a higher PWV and positive ischemia had the most CV events (hazard ratio 8.94, p < 0.001). The group with a higher PWV and negative ischemia also was significantly associated with CV events (HR 2.19, p = 0.02). Groups with a lower PWV-positive ischemia and a higher PWV-negative ischemia showed no difference in terms of CV events (HR 0.60, p = 0.08). Patients with myocardial ischemia who had higher PWV demonstrated significantly higher event rates than those who had lower PWV (HR 2.41, p < 0.001). Multivariate analysis demonstrated that myocardial ischemia and PWV were independent predictors for combined CV events (HR 2.71, p < 0.001 and HR 2.42, p < 0.001, respectively).ConclusionsStress perfusion CMR provided prognostic utility in patients with known or suspected CAD. Adding aortic stiffness to stress perfusion CMR could improve risk assessment and prediction for future CV events.
Highlights
Aortic stiffness is an independent predictor of cardiovascular (CV) events and mortality
The three main findings of this study were 1) aortic stiffness measured by cardiac magnetic resonance (CMR) independently predicted composite cardiovascular events in patients with known or suspected coronary artery disease (CAD) underwent adenosine stress test; 2) the presence of inducible myocardial ischemia was a powerful predictor for cardiovascular events; and 3) the combination of aortic stiffness and myocardial ischemia provided significant improvement of prognostic predictions
The pulse wave velocity (PWV) measured by CMR in our study demonstrated excellent images with significantly high reliability comparable to the previous studies [19]
Summary
Aortic stiffness is an independent predictor of cardiovascular (CV) events and mortality. Using cardiac magnetic resonance (CMR) imaging, we assessed the association of aortic stiffness by pulse wave velocity (PWV), myocardial ischemia, and CV events in patients with known or suspected coronary artery disease (CAD). Measurement of aortic stiffness can be performed by several methods, such as carotid-femoral pulse wave velocity (PWV) using a tonometer, computed tomography, or cardiac magnetic resonance (CMR) imaging. The advantages of PWV using CMR include the provision of crosssectional images covering the desired length of the aorta, a high spatial resolution, direct measurement of the aorta length without geometric assumptions of the distance (in contrast to tonometer), a lack of ionizing radiation, and the ability to evaluate other aspects of the aorta (such as aortic wall strain and deformation) [17, 18]. CMR-based PWV measurements have been well validated (compared with invasive pressure recordings), and they have a high reproducibility [19]
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