Introduction
Methods
Patients
Acquisition of CMR images
Acquisition of PC cine CMR data from the coronary sinus
CMR image analysis
Follow-up of adverse events
Statistical analyses
Results
Patient characteristics
All patients N = 1212 | Patients with known CAD N = 693 | Patients with suspected CAD N = 519 | *P-value | |
---|---|---|---|---|
Clinical variables | ||||
Age, years | 69 ± 10 | 69 ± 10 | 68 ± 11 | 0.37 |
Male | 921 (76%) | 554 (80%) | 367 (71%) | < 0.005 |
BMI, kg/m2 | 24 ± 3 | 24 ± 3 | 24 ± 4 | 0.49 |
Hypertension | 823 (68%) | 483 (70%) | 340 (66%) | 0.13 |
Dyslipidemia | 821 (68%) | 488 (70%) | 333 (64%) | 0.021 |
Diabetes mellitus | 366 (30%) | 229 (33%) | 137 (26%) | 0.012 |
Current smoking | 79 (7%) | 55 (8%) | 24 (5%) | 0.021 |
Blood test | ||||
HbA1c, % | 6.0 ± 0.8 | 6.1 ± 0.9 | 5.9 ± 0.7 | 0.005 |
LDL cholesterol | 99 ± 28 | 94 ± 27 | 107 ± 30 | < 0.001 |
eGFR | 66 ± 16 | 67 ± 16 | 66 ± 15 | 0.42 |
CMR variables | ||||
LVEDV, mL | 131 ± 46 | 128 ± 42 | 134 ± 51 | 0.053 |
LVESV, mL | 57 ± 37 | 55 ± 33 | 59 ± 42 | 0.24 |
LV mass, g | 95 ± 34 | 92 ± 36 | 99 ± 31 | < 0.001 |
LVEF, % | 60 ± 12 | 60 ± 12 | 59 ± 12 | 0.84 |
Presence of LGE | 591 (49%) | 439 (63%) | 152 (29%) | < 0.001 |
LGE, % | 7.9 ± 9.0 | 9.6 ± 9.6 | 5.9 ± 7.7 | < 0.001 |
Presence of ischemia | 516 (43%) | 195 (28%) | 321 (62%) | 0.002 |
> 10% ischemia | 258 (21%) | 175 (25%) | 83 (16%) | < 0.001 |
Comparison of the CSBF and CFR between patients with and without MACE
Patients with known CAD | All patients N = 693 | Patients without MACE N = 648 | Patients with MACE N = 45 | *P-value |
---|---|---|---|---|
CSBF at rest (mL/min) | 86.7 ± 32.9 | 84.7 ± 30.9 | 114.7 ± 44.9 | < 0.001 |
CSBF during ATP infusion (mL/min) | 236.4 ± 87.4** | 235.8 ± 88.7** | 245.3 ± 66.5** | 0.47 |
ΔCSBF (mL/min) | 149.7 ± 72.7 | 151.1 ± 73.8 | 130.6 ± 50.9 | 0.068 |
Coronary flow reserve | 2.84 ± 0.91 | 2.89 ± 0.92 | 2.27 ± 0.60 | < 0.001 |
Patients with suspected CAD | All patients N = 519 | Patients without MACE N = 472 | Patients with MACE N = 47 | *P-value |
---|---|---|---|---|
CSBF at rest (mL/min) | 89.8 ± 37.8 | 86.6 ± 36.7 | 122.2 ± 33.3 | < 0.001 |
CSBF during ATP infusion (mL/min) | 242.4 ± 87.4** | 241.6 ± 90.3** | 250.2 ± 48.5** | 0.52 |
ΔCSBF (mL/min) | 152.6 ± 70.1 | 155.1 ± 72.1 | 127.9 ± 39.2 | 0.011 |
Coronary flow reserve | 2.85 ± 0.84 | 2.93 ± 0.84 | 2.10 ± 0.40 | < 0.001 |
Prognostic value of resting CSBF for predicting MACE
Prognostic value of rest CSBF, CFR and stress perfusion CMR
Known CAD N = 693 | Suspected CAD N = 519 | |||||||
---|---|---|---|---|---|---|---|---|
Multivariable model 1* | Multivariable model 2↑ | Multivariable model 1* | Multivariable model 2↑ | |||||
Hazard ratio (95% CI) | P-value | Hazard ratio (95% CI) | P-value | Hazard ratio (95% CI) | P-value | Hazard ratio (95% CI) | P-value | |
Age | 1.04 (1.00–1.07) | 0.022 | 1.03 (0.99–1.07) | 0.034 | 1.08 (1.04–1.12) | < 0.001 | 1.04 (1.00–1.08) | 0.023 |
Male | 0.60 (0.25–1.44) | 0.25 | 0.66 (0.26 –1.62) | 0.36 | 1.72 (0.79–3.72) | 0.16 | 2.13 (0.94–4.85) | 0.068 |
Hypertension | 0.97 (0.39–2.37) | 0.94 | 0.87 (0.36–2.10) | 0.76 | 1.16 (0.54–2.47) | 0.69 | 1.15 (0.54–2.46) | 0.71 |
Dyslipidemia | 0.79 (0.34–1.89) | 0.60 | 0.82 (0.36–1.89) | 0.64 | 0.78 (0.38–1.61) | 0.51 | 0.36 (0.16–0.77) | 0.42 |
Diabetes mellitus | 0.92 (0.48–1.80) | 0.82 | 1.49 (0.81–2.73) | 0.19 | 1.50 (0.79–2.84) | 0.20 | 1.17 (0.62–2.23) | 0.61 |
LVEF | 0.95 (0.92–0.97) | < 0.001 | 0.95 (0.92–0.97) | < 0.001 | 0.98 (0.96–1.00) | 0.11 | 0.99 (0.97–1.00) | 0.21 |
LV mass | 0.99 (0.99–1.01) | 0.90 | 0.99 (0.98–1.01) | 0.70 | 0.98 (0.97–1.00) | 0.11 | 0.98 (0.97–1.00) | 0.026 |
Presence of LGE | 1.27 (0.48–3.35) | 0.62 | 1.40 (0.68–2.88) | 0.35 | ||||
%LGE | 0.98 (0.95–1.02) | 0.31 | 0.96 (0.91–1.00) | 0.042 | ||||
Ischemia > 10% | 4.96 (2.50–9.83) | < 0.001 | 7.62 (3.69–15.7) | < 0.001 | ||||
Ischemia extent | 1.06 (1.03–1.08) | < 0.001 | 1.07 (1.04–1.09) | < 0.001 | ||||
Rest CSBF > median | 3.18 (1.34–7.51) | 0.0083 | 23.3 (5.19–104.9) | < 0.001 | ||||
Rest CSBF | 1.01 (1.00–1.02) | < 0.001 | 1.02 (1.01–1.02) | < 0.001 |