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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.|
Greenwood, John P.
Dawson, Dana K.
Kelly, Damian J.
Lang, Chim C.
Khoo, Jeffrey P.
Steeds, Richard P.
Squire, Iain B.
Samani, Nilesh J.
McCann, Gerry P.
|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. ClinicalTrials.gov (NCT01658345).|
|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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|PRIMID_EHJ_FINAL accepted version.pdf||Post-review (final submitted author manuscript)||1.04 MB||Adobe PDF||View/Open|
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