Long-term prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance in patients with hypertension without known coronary artery disease

Several studies have shown the excellent prognostic value of stress cardiovascular magnetic resonance (CMR) in large cohorts of patients without known coronary artery disease (CAD). However, its prognostic value in a dedicated cohort of patients in primary prevention with hypertension remains not well established.

The aim of our study was to assess the long-term prognostic value of vasodilator stress perfusion CMR in patients with hypertension without known CAD.

Between December 2008 and January 2022, we conducted a bi-centre longitudinal study with consecutive patients with hypertension, and without a known CAD, referred for vasodilator stress perfusion CMR to 2 hospitals. All patients were followed up to the occurrence of major cardiovascular events (MACE), defined as cardiovascular mortality or non-fatal myocardial infarction (MI). Cox regressions analyses were performed to determine the prognostic value of each parameter.

Among 2,019 patients (mean age 68.7± 11.7 years; 45.4% male) with a median follow up of 6.7 years, 335 had MACE (16.6%). Patients without inducible ischaemia experienced a lower rate of MACE than those with an inducible ischaemia (12.1 versus 41.3%, respectively, p<0.001). In univariate analysis, inducible ischaemia and unrecognised MI were significantly associated with the occurrence of MACE (hazard ratio [HR]: 4.39; 99.5% confidence interval [CI]: 3.20-6.02 and HR: 99.5%CI: 2.49-4.89, respectively; both p<0.001).

In multivariable analysis, the extent of inducible ischaemia and unrecognised MI were independent predictors of a higher incidence of MACE (HR: 1.27, 99.5% CI: 1.14-1.40, and HR: 1.22, 99.5%CI: 1.08-1.37 respectively, both p<0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional prognostic factors (net reclassification improvement: 0.399; integrative discrimination index: 0.014; both p<0.001).

In patients with hypertension and without known CAD, vasodilator stress CMR has independent and incremental prognostic value to predict MACE over traditional prognostic factors.

Survival curves for MACE