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

Anvesha Singh, John P Greenwood, Colin Berry, Dana K Dawson, Kai Hogrefe, Damian J Kelly, Vijay Dhakshinamurthy, Chim C Lang, Jeffrey P Khoo, David Sprigings, Richard P Steeds, Michael Jerosch-Herold, Stefan Neubauer, Bernard Prendergast, Bryan Williams, Ruiqi Zhang, Ian Hudson, Iain B Squire, Ian Ford, Nilesh J SamaniGerry P McCann

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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).
Original languageEnglish
Pages (from-to)1222–1229
Number of pages8
JournalEuropean Heart Journal
Volume38
Issue number16
Early online date13 Feb 2017
DOIs
Publication statusPublished - 21 Apr 2017

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Keywords

  • aortic stenosis
  • exercise testing
  • magnetic resonance imaging
  • myocardial perfusion reserve

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