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• W4313443908 abstract "Cardiovascular disease is the main cause of death in chronic kidney disease (CKD) patients. Athough several studies demonstrated the high prognostic value of stress cardiovascular magnetic resonance (CMR), this prognostic value was not established in CKD patients. To assess the prognostic value of vasodilator stress CMR in patients with known CKD. Between December 2008 and January 2021, we conducted a bi-center longitudinal study with consecutive patients with known CKD, defined by glomerular filtration rate (GFR) < 60 mL/min/1.73 m2, referred for vasodilator stress perfusion CMR in the Institut cardiovasculaire Paris Sud (ICPS, Massy) and Lariboisière University Hospital (AP–HP, Paris). All patients with GFR < 30 mL/min/1.73 m2 (n = 62) were excluded due the risk of nephrogenic systemic fibrosis. All patients were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. Of 825 patients with known CKD (71.4 ± 8.8 years, 70% men), 769 (93%) completed the CMR protocol, and among those 702 (91%) completed the follow-up (median follow-up 6.4 (4.0–8.2) years). Reasons for failure to complete CMR included claustrophobia (n = 28), ECG-gating problems (n = 12), intolerance to stress agent (n = 9), and declining participation (n = 7). Stress CMR was well tolerated without occurrence of death or severe adverse event. Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 12.50; 95% confidence interval CI: 7.50–20.8; P < 0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 15.50; 95% CI: 7.72–30.9; P < 0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI = 0.477; IDI = 0.049) (Fig. 1). Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE in patients with known CKD." @default.
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• W4313443908 date "2023-01-01" @default.
• W4313443908 modified "2023-09-26" @default.
• W4313443908 title "Incremental prognostic value of stress CMR for cardiovascular risk stratification in patients with known chronic kidney disease" @default.
• W4313443908 doi "https://doi.org/10.1016/j.acvdsp.2022.10.120" @default.
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