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PROGNOSTIC UTILITY OF CARDIAC INDEX MEASURED BY CMR IN PATIENTS WITH CORONARY ARTERY DISEASE
2093 JACC April 5, 2016 Volume 67, Issue 13
Stable Ischemic Heart Disease PROGNOSTIC UTILITY OF CARDIAC INDEX MEASURED BY CMR IN PATIENTS WITH CORONARY ARTERY DISEASE Moderated Poster Contributions Stable Ischemic Heart Disease Moderated Poster Theater, Poster Area, South Hall A1 Sunday, April 03, 2016, 10:15 a.m.-10:25 a.m. Session Title: Testing and Treatment to Enhance Prognosis in Patients With SIHD Abstract Category: 38. Stable Ischemic Heart Disease: Clinical Presentation Number: 1195M-05 Authors: Ahmed Abdi Ali, Robert Miller, Danielle Southern, Mei Zhang, Yoko Mikami, Bobak Heydari, Carmen Lydell, Andrew Howarth, Matthew James, Stephen Wilton, Merril Knudtson, James White, University of Calgary, Calgary, Canada
Background: Cardiac Index (CI) reflects cumulative stroke volume per minute indexed to body surface area, a more accurate reflection of cardiac performance in the setting of myocardial disease. In this study, we assess the prognostic utility of cardiovascular magnetic resonance (CMR) derived CI for prediction of all-cause mortality among a large cohort of patients with suspected CAD.
Methods: Patients records from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Program, a prospective registry of patients undergoing coronary angiography, were screened to identify those who underwent CMR imaging within 6 months of coronary angiography (mean interval 1.0 +/- 1.5 months). Among 99,667 patients enrolled between April 2002 and Mar 2013, a total of 3, 754 (3.8%) met criteria (mean age 59.3 +/- 13.1 years and LVEF 45.7 +/- 16.3%). Both EF and CI were determined without knowledge of patient outcomes. We assessed the interaction between CI and all-cause mortality using a multivariable cox proportional hazards model adjusting for all baseline clinical characteristics and extent of CAD. Additionally, we tested the a-priori hypothesis that a CI below 2.0 ml/min/m2 is an incremental predictor of adverse outcomes among patients with and without severe LV systolic dysfunction, defined as an LVEF <35%.
Results: The primary outcome, occurred in 315 (8.4%) patients at a median follow-up of 44.9 months. Severe LV systolic dysfunction was identified in 984 (27.1%) patients. Multivariable analysis showed CI<2.0 to be an independent predictor of the primary outcome following adjustment for all baseline variables in addition to LVEF (adjusted HR 1.56 (95% CI 1.16, 2.1). Sub-group analysis of patients with an LVEF ≥35% showed improved predictive utility with an adjusted HR of 1.82 (95% CI 1.1, 3.1) versus 0.85 (95% CI 0.65, 1.11) in those with LVEF <35%. Conclusions: Among patients with suspected CAD referred for coronary angiography, CI is an independent predictor of all-cause mortality and provides incremental value beyond LVEF alone. In particular, patients with less severe systolic dysfunction (LVEF ≥35%) show a 1.8 fold higher risk of death when cardiac index falls below 2.0.
Stable Ischemic Heart Disease PROGNOSTIC UTILITY OF CARDIAC INDEX MEASURED BY CMR IN PATIENTS WITH CORONARY ARTERY DISEASE Moderated Poster Contributions Stable Ischemic Heart Disease Moderated Poster Theater, Poster Area, South Hall A1 Sunday, April 03, 2016, 10:15 a.m.-10:25 a.m. Session Title: Testing and Treatment to Enhance Prognosis in Patients With SIHD Abstract Category: 38. Stable Ischemic Heart Disease: Clinical Presentation Number: 1195M-05 Authors: Ahmed Abdi Ali, Robert Miller, Danielle Southern, Mei Zhang, Yoko Mikami, Bobak Heydari, Carmen Lydell, Andrew Howarth, Matthew James, Stephen Wilton, Merril Knudtson, James White, University of Calgary, Calgary, Canada
Background: Cardiac Index (CI) reflects cumulative stroke volume per minute indexed to body surface area, a more accurate reflection of cardiac performance in the setting of myocardial disease. In this study, we assess the prognostic utility of cardiovascular magnetic resonance (CMR) derived CI for prediction of all-cause mortality among a large cohort of patients with suspected CAD.
Methods: Patients records from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Program, a prospective registry of patients undergoing coronary angiography, were screened to identify those who underwent CMR imaging within 6 months of coronary angiography (mean interval 1.0 +/- 1.5 months). Among 99,667 patients enrolled between April 2002 and Mar 2013, a total of 3, 754 (3.8%) met criteria (mean age 59.3 +/- 13.1 years and LVEF 45.7 +/- 16.3%). Both EF and CI were determined without knowledge of patient outcomes. We assessed the interaction between CI and all-cause mortality using a multivariable cox proportional hazards model adjusting for all baseline clinical characteristics and extent of CAD. Additionally, we tested the a-priori hypothesis that a CI below 2.0 ml/min/m2 is an incremental predictor of adverse outcomes among patients with and without severe LV systolic dysfunction, defined as an LVEF <35%.
Results: The primary outcome, occurred in 315 (8.4%) patients at a median follow-up of 44.9 months. Severe LV systolic dysfunction was identified in 984 (27.1%) patients. Multivariable analysis showed CI<2.0 to be an independent predictor of the primary outcome following adjustment for all baseline variables in addition to LVEF (adjusted HR 1.56 (95% CI 1.16, 2.1). Sub-group analysis of patients with an LVEF ≥35% showed improved predictive utility with an adjusted HR of 1.82 (95% CI 1.1, 3.1) versus 0.85 (95% CI 0.65, 1.11) in those with LVEF <35%. Conclusions: Among patients with suspected CAD referred for coronary angiography, CI is an independent predictor of all-cause mortality and provides incremental value beyond LVEF alone. In particular, patients with less severe systolic dysfunction (LVEF ≥35%) show a 1.8 fold higher risk of death when cardiac index falls below 2.0.