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

• Published in: European heart journal Vol. 38; no. 16; pp. 1222 - 1229
• Main Authors: Singh, Anvesha, Greenwood, John P, Berry, Colin, Dawson, Dana K, Hogrefe, Kai, Kelly, Damian J, Dhakshinamurthy, Vijay, Lang, Chim C, Khoo, Jeffrey P, Sprigings, David, Steeds, Richard P, Jerosch-Herold, Michael, Neubauer, Stefan, Prendergast, Bernard, Williams, Bryan, Zhang, Ruiqi, Hudson, Ian, Squire, Iain B, Ford, Ian, Samani, Nilesh J, McCann, Gerry P
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 21.04.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aortic Valve Stenosis - physiopathology; Area Under Curve; Clinical Research; Coronary Circulation - physiology; Editor's Choice; Exercise Test; Exercise Tolerance - physiology; Female; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Prognosis; Prospective Studies; Young Adult; Myocardial perfusion reserve; Aortic stenosis; Magnetic resonance imaging; Exercise testing
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehx001

To assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS. 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. 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).