Aortic Stiffness Effectively Risk Stratifies Diabetic Patients With Suspected Myocardial Ischemia Undergoing Vasodilatory Stress Perfusion Cardiac Magnetic Resonance

Abstract

Abstract Background and aims Cardiovascular magnetic resonance (CMR) comprehensively assesses aortic stiffness and myocardial ischemia in a single examination. Aortic stiffness represents a subclinical marker of cardiovascular risk in the general population, including patients with diabetes mellitus. However, there is no prognostic data regarding aortic stiffness in patients with diabetes mellitus undergoing stress perfusion CMR.Methods Consecutive patients with diabetes mellitus with suspected myocardial ischemia referred for adenosine stress perfusion CMR with aortic pulse wave velocity (PWV) during 2010–2013 were studied. The primary outcome was major adverse cardiovascular events (MACE) defined as the composite of cardiac mortality, nonfatal myocardial infarction (MI), hospitalization for heart failure, coronary revascularization (> 90 days post-CMR), and ischemic stroke. The secondary outcome was hard cardiac events defined as the composite of cardiac mortality and nonfatal MI.Results A total of 424 patients (median follow-up: 7.2 years) were included. The mean PWV was 12.16 ± 6.28 m/s. MACE and hard cardiac events occurred in 26.9% and 9.4% of patients, respectively. Patients with elevated PWV (> 12.16 ms) had a significantly higher incidence of MACE (HR: 2.14, p < 0.001) and hard cardiac events (HR: 2.69, p = 0.002) compared to non-elevated patients. Multivariate analysis showed that PWV independently predicts MACE (p = 0.002) and hard cardiac events (p = 0.01). The addition of PWV conferred significantly increased incremental prognostic value over clinical data, left ventricular ejection fraction, myocardial ischemia, and late gadolinium enhancement for predicting MACE (incremental χ²: 10.29, p = 0.001) and hard cardiac events (incremental χ²: 7.32, p = 0.007).Conclusions Aortic stiffness by CMR independently predicts MACE and hard cardiac events and confers significant incremental prognostic value in patients with diabetes mellitus with suspected myocardial ischemia. Aortic stiffness measurement could be incorporated into a stress perfusion CMR protocol to improve risk prediction in this group.