Research Article
Cardiac Magnetic Resonance in Stable Coronary Artery Disease: Added Prognostic Value to Conventional Risk Profiling
Table 2
Univariate Cox analysis of conventional assessment and CMR metrics for all-cause mortality and MACE.
| | | All-Cause Mortality | MACE | | | Hazard Ratio (95%CI) | P Value | Hazard Ratio (95%CI) | P Value |
| | ANTHROPOMETRIC | | | | | | Age (≥75 years) | 2.6 (1.4−4.9) | 0.003 | 1.6 (1.0−2.4) | 0.036 | | Male sex | 1.1 (0.8−1.5) | 0.577 | 1.0 (0.8−1.2) | 0.674 | | Body mass index (>30) | 1.5 (0.8−3.0) | 0.244 | 1.1 (0.7−1.8) | 0.668 | | RISK FACTORS | | | | | | Family history of CAD | 0.8 (0.4−1.4) | 0.391 | 0.9 (0.6−1.3) | 0.609 | | Smoking (previous or active) | 2.2 (1.2−3.5) | 0.017 | 1.7 (1.2−2.3) | 0.005 | | Diabetes | 1.4 (1.2−4.2) | 0.206 | 1.5 (1.0−2.1) | 0.056 | | Hypertension | 0.8 (0.5−1.4) | 0.488 | 1.1 (0.8−1.6) | 0.448 | | Hypercholesterolemia | 1.1 (0.6−2.2) | 0.714 | 1.2 (0.9−1.8) | 0.258 | | No. of CV risk factors (≥3) | 1.5 (0.8−2.6) | 0.168 | 1.6 (1.1−2.2) | 0.013 | | CLINIC | | | | | | Previous CAD diagnosis | 4,2 (1.0−17.3) | 0.046 | 2.4 (1.3−4.6) | 0.007 | | Previous myocardial infarction | 2.7 (1.3−5.6) | 0.006 | 1.2 (0.8−1.7) | 0.392 | | LM or 3-vessel CAD | 1.5 (0.8−2.6) | 0.166 | 2.3 (1.6−3.2) | <0.001 | | NYHA classification (≥III) | 3.3 (1.2−9.2) | 0.022 | 2.5 (1.2−5.4) | 0.018 | | Revascularization in the follow-up | 0.4 (0.2−0.9) | 0.037 | - | | | ACS in the follow-up | 4.9 (2.2−10.8) | <0.001 | - | | | THERAPY | | | | | | β-blockers | 1.2 (0.6−2.3) | 0.536 | 1.0 (0.7−1.5) | 0.941 | | Ca++-antagonist | 1.2 (0.6−2.3) | 0.536 | 1.1 (0.7−1.7) | 0.556 | | Nitrates | 1.3 (0.7−2.2) | 0.380 | 1.1 (0.8−1.6) | 0.473 | | Loop diuretics | 2.2 (1.3−3.9) | 0.005 | 1.5 (1.1−2.2) | 0.021 | | Aldosterone antagonist | 2.4 (1.2−4.8) | 0.013 | 1.4 (0.9−2.3) | 0.158 | | ACE-inhibitors/ARB | 0.9 (0.5−1.8) | 0.841 | 1.3 (0.8−2.0) | 0.297 | | ASA | 1.7 (0.7−4.3) | 0.262 | 1.3 (0.8−2.2) | 0.253 | | Statins | 1.0 (0.5−2.0) | 0.943 | 1.0 (0.6−1.4) | 0.831 | | Anticoagulant | 2.3 (1.0−5.5) | 0.053 | 1.9 (1.1−4.4) | 0.027 | | ECG | | | | | | Heart rate (>75 bpm) | 2.3 (1.2−4.3) | 0.011 | 1.7 (1.1−2.6) | 0.018 | | Non sinus rhythm | 2.8 (0.9−9.1) | 0.082 | 2.2 (1.0−4.8) | 0.038 | | QRS duration (>120 msec) | 3.4 (1.9−6.3) | <0.001 | 2.1 (1.4−3.3) | <0.001 | | QTc interval (≥460 msec) | 3.3 (1.8−6.2) | <0.001 | 1.6 (1.0−2.6) | 0.035 | | LV hypertrophy | 1.4 (0.7−2.8) | 0.380 | 1.2 (0.7−1.9) | 0.483 | | LBBB | 2.3 (1.2−4.4) | 0.013 | 1.7 (1.0−2.7) | 0.032 | | RBBB | 1.4 (0.6−2.9) | 0.431 | 1.4 (0.9−2.2) | 0.161 | | ST segment depression | 1.4 (0.5−3.8) | 0.537 | 1.7 (0.9−3.2) | 0.089 | | Negative T waves | 1.9 (1.1−3.4) | 0.028 | 1.4 (1.0−1.8) | 0.048 | | Q waves | 1.1 (0.6−1.9) | 0.774 | 1.3 (1.0−2.0) | 0.101 | | ECHOCARDIOGRAPHY | | | | | | LVEDV (≥105 ml/m2)§ | 3.6 (1.7−7.7) | 0.001 | 1.4 (0.7−2.7) | 0.370 | | LVESV (≥75 ml/m2)§ | 9.4 (4.4−20.2) | <0.001 | 2.4 (1.2−4.9) | 0.016 | | LVEF (≤30%) | 8.0 (4.0−16.0) | <0.001 | 3.2 (1.9−5.5) | <0.001 | | LVWMSI (≥2.32)§ | 5.5 (2.2−13.9) | <0.001 | 3.3 (1.7−6.5) | 0.001 | | LV mass (≥310 g)§ | 4.4 (2.0−9.4) | <0.001 | 2.0 (1.1−3.6) | 0.025 | | LV diastolic dysfunction (≥pseudo-normal)† | 2.3 (1.1−4.8) | 0.035 | 1.8 (1.1−3.0) | 0.025 | | Mitral regurgitation (≥moderate)‡ | 2.5 (1.3−4.7) | 0.005 | 1.5 (0.9−2.3) | 0.098 | | Pulmonary hypertension (sPAP>35 mmHg) | 2.3 (1.0−5.1) | 0.040 | 1.7 (1.0−2.8) | 0.065 | | RVIT dilatation (>40 mm) | 1.0 (0.3−3.2) | 0.989 | 1.1 (0.5 – 2.2) | 0.892 | | RV dysfunction (TAPSE<15 mm) | 2.2 (1.0−4.9) | 0.053 | 1.1 (0.6−2.1) | 0.706 | | CMR | | | | | | CMR LVEDV (≥122 ml/m2)§ | 6.7 (3.1−14.4) | <0.001 | 3.0 (1.6−5.8) | 0.001 | | CMR LVEF (<35%) | 5.4 (3.0−9.6) | <0.001 | 2.6 (1.7−4.0) | <0.001 | | CMR LV mass (≥236 g)§ | 3.5 (1.4−8.7) | 0.008 | 1.4 (0.6−3.5) | 0.443 | | CMR LGE (>40%)§ | 7.6 (3.0−19.2) | <0.001 | 5.1 (2.7−9.4) | <0.001 | | CMR myocardial stress induced perfusion abnormality | 1.1 (0.5−2.2) | 0.881 | 2.3 (1.6 – 3.5) | <0.001 |
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CMR = cardiovascular magnetic resonance; MACE = major adverse cardiac events; CAD = coronary artery disease; CV = cardiovascular; LM= left main; NYHA =New York heart association; ACS = acute coronary syndrome; ACE =angiotensin converting enzyme; ARB = angiotensin receptor blocker; ASA =acetylsalicylic acid; LBBB = left bundle branch block; RBBB = right bundle branch block; LVEDV = left ventricular end diastolic volume; LVESV = left ventricular end systolic volume; LVEF = left ventricular ejection fraction; LVWMSI = left ventricular wall motion score index; LV = left ventricle/ventricular; sPAP = systolic pulmonary artery pressure; RVIT = right ventricular inflow tract; RV = right ventricle; TAPSE = tricuspid annular plane systolic excursion; LGE = late gadolinium enhancement.
† based on trans-mitral diastolic flow and pulmonary vein flow evaluation.
‡ based on effective regurgitant orifice area.
§ cut-off equal to the 95% percentile of the entire population.
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