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Title: 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.
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.
First Published: 13-Feb-2017
Publisher: Oxford University Press (OUP) for European Society of Cardiology
Citation: European Heart Journal, 2017, 0, 1–8
Abstract: Aims To assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS. Methods and results 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. Conclusions 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. (NCT01658345).
DOI Link: 10.1093/eurheartj/ehx001
ISSN: 0195-668X
eISSN: 1522-9645
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2017, Oxford University Press (OUP) for European Society of Cardiology. Deposited with reference to the publisher’s open access archiving policy.
Description: Supplementary material is available at European Heart Journal online.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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