Prognostic Value of Aortic Stiffness using Cardiovascular Magnetic Resonance in The Elderly with Known or Suspected Coronary Artery Disease

Kaolawanich, Yodying; Boonyasirinant, Thananya

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Original Article • Arq. Bras. Cardiol. 118 (5) • May 2022 • https://doi.org/10.36660/abc.20210452 copy

Prognostic Value of Aortic Stiffness using Cardiovascular Magnetic Resonance in The Elderly with Known or Suspected Coronary Artery Disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Aortic stiffness is established as a marker of cardiovascular disease. Cardiovascular magnetic resonance (CMR) provides a comprehensive assessment of aortic stiffness and myocardial ischemia in a single examination. However, prognostic data concerning aortic stiffness in elderly patients remain limited.

Objective

To determine the prognostic value of aortic stiffness using CMR-based pulse wave velocity (PWV) in elderly patients with known or suspected coronary artery disease (CAD).

Methods

This study enrolled consecutive patients aged >70 referred for adenosine stress perfusion CMR including PWV between 2010 and 2014. Patients were followed up for occurrence of major adverse cardiovascular events (MACE), including cardiac mortality, nonfatal myocardial infarction, hospitalization for heart failure, late revascularization (>180 days after CMR), and ischemic stroke. Univariable and multivariable analyses were performed to determine the predictors of MACE. A p-value of <0.05 is considered statistically significant.

Results

Mean PWV was 13.98±9.00 m/s. After a median follow-up period of 59.6 months in 263 patients (55% female, 77±5 years), 61 MACE occurred. Patients with elevated PWV (>13.98 m/s) had significantly higher rates of MACE (HR 1.75; 95% CI 1.05-2.94; p=0.03) than those with non-elevated PWV (<13.98 m/s). Multivariate analysis demonstrated diastolic blood pressure, left ventricular ejection fraction (LVEF), myocardial ischemia, and elevated PWV as independent predictors for MACE (p<0.05 for all). PWV provided an incremental prognostic value over clinical data, LVEF, and ischemia (increased global chi-square=7.25, p=0.01).

Conclusion

Aortic stiffness using CMR is a strong and independent predictor of cardiovascular events in elderly patients with known or suspected CAD.

Aortic Stiffness; Cardiovascular Magnetic Resonance; Coronary Artery Disease; Elderly; Prognosis

	Total (n=263)	Elevated PWV (n=83)	Non-elevated PWV (n=180)	p-Value
Age (years)	77.3±5.2	77.9±5.1	77.1±5.2	0.19
Female	144 (54.8)	50 (60.2)	94 (52.2)	0.23
Body mass index (kg/m²)	26.3±4.1	26±4.1	26.4±4.2	0.49
Systolic BP (mmHg)	139.3±19.7	144.7±18.1	136.9±19.9	0.003
Diastolic BP (mmHg)	70.5±11.1	71.4±11.3	70.2±10.9	0.42
Heart rate (beats/minute)	76.6±13.9	76.6±15.5	76.6±13.2	0.99
Clinical history
Hypertension	235 (89.4)	81 (97.6)	154 (85.6)	0.01
Diabetes mellitus	145 (55.1)	58 (69.9)	87 (48.3)	0.001
Hyperlipidemia	197 (74.9)	60 (72.3)	137 (76.1)	0.51
Coronary artery disease	55 (20.9)	20 (24.1)	35 (19.4)	0.39
Prior revascularization	12 (4.6)	4 (4.8)	8 (4.4)	0.89
Ischemic stroke	13 (4.9)	3 (3.6)	10 (5.6)	0.50
Cigarette smoker	28 (10.6)	7 (8.4)	21 (11.7)	0.43
Medications
ACEI or ARB	130 (49.4)	43 (51.8)	87 (48.3)	0.60
Aspirin	134 (50.9)	45 (54.2)	89 (49.4)	0.47
Beta blocker	124 (47.2)	38 (45.8)	86 (47.8)	0.76
Calcium channel blocker	96 (36.5)	27 (32.5)	69 (38.3)	0.36
Statin	147 (55.9)	50 (60.2)	97 (53.9)	0.34
CMR
LV mass (g)	84.3±24.5	83.6±25.5	84.7±24.0	0.74
LV ejection fraction (%)	68.1±15.1	69.8±14.1	67.3±15.5	0.21
Myocardial ischemia	95 (36.1)	28 (33.7)	67 (37.2)	0.58
Late gadolinium enhancement	39 (14.8)	15 (18.1)	24 (13.3)	0.32
PWV (m/s)	13.98±9.00	22.09±12.28	10.24±2.22	<0.001

	Univariate Analysis		Multivariate Analysis

	HR (95% CI)	p-Value	HR (95% CI)	p-Value
Age (years)	1.03 (0.98. 1.09)	0.19
Female	1.39 (0.82. 2.35)	0.23
Body mass index (kg/m²)	0.98 (0.92. 1.04)	0.49
Systolic BP (per 10 mmHg)	1.23 (1.07. 1.41)	0.003	1.23 (1.07. 1.42)	0.01
Diastolic BP (per 10 mmHg)	1.10 (0.87. 1.40)	0.42
Hypertension	6.84 (1.58. 29.54)	0.01	6.06 (1.36. 26.97)	0.02
Diabetes mellitus	2.48 (1.43. 4.31)	0.001	2.09 (1.18. 3.70)	0.01
Hyperlipidemia	0.82 (0.45. 1.48)	0.51
Coronary artery disease	1.32 (0.71. 2.54)	0.39
Prior revascularization	1.09 (0.32. 3.72)	0.89
Ischemic stroke	0.64 (0.17. 2.38)	0.50
Cigarette smoker	0.70 (0.28. 1.71)	0.43
ACEI or ARB	1.15 (0.68. 1.93)	0.60
Aspirin	1.21 (0.72. 2.04)	0.47
Beta blocker	0.92 (0.55. 1.56)	0.76
Calcium channel blocker	0.78 (0.45. 1.34)	0.36
Statin	1.30 (0.76. 2.20)	0.34
LV mass (g)	0.99 (0.98. 1.01)	0.74
LV ejection fraction (per 10%)	1.13 (0.94. 1.35)	0.21
Myocardial ischemia	0.86 (0.50. 1.48)	0.58
Late gadolinium enhancement	1.43 (0.71. 2.90)	0.32

	Total (n=263)	Elevated PWV (n=83)	Non-elevated PWV (n=180)	HR (95% CI)	p-Value
MACE^a	61 (23.2)	24 (28.9)	37 (20.6)	1.75 (1.05. 2.94)	0.03
Cardiac mortality	5 (1.9)	2 (2.4)	3 (1.7)	1.68 (0.28. 10.07)	0.57
Nonfatal myocardial infarction	24 (9.1)	9 (10.8)	15 (8.3)	1.60 (0.70. 3.67)	0.27
Hospitalization for heart failure	36 (13.7)	15 (18.1)	21 (11.7)	1.94 (0.99. 3.81)	0.05
Late coronary revascularization	16 (6.1)	5 (6.0)	11 (6.1)	1.17 (0.41. 3.39)	0.77
Ischemic stroke	11 (4.2)	7 (8.4)	4 (2.2)	5.04 (1.47. 17.32)	0.01

	Univariate Analysis		Multivariate Analysis

	HR (95% CI)	p-Value	HR (95% CI)	p-Value
Age (years)	1.03 (0.98. 1.08)	0.29	1.02 (0.97. 1.08)	0.43
Female	1.01 (0.61. 1.67)	0.98
Body mass index (kg/m²)	0.95 (0.89. 1.01)	0.08
Systolic BP (per 10 mmHg)	0.89 (0.78. 1.02)	0.10
Diastolic BP (per 10 mmHg)	0.75 (0.59. 0.96)	0.01	0.76 (0.59. 0.97)	0.03
Hypertension	1.49 (0.60. 3.71)	0.40
Diabetes mellitus	1.17 (0.70. 1.94)	0.55
Hyperlipidemia	1.37 (0.73. 2.58)	0.33
Coronary artery disease	1.80 (1.02. 3.17)	0.04	1.25 (0.69. 2.26)	0.47
Prior revascularization	1.56 (0.62. 3.89)	0.35
Ischemic stroke	0.63 (0.15. 2.58)	0.52
Cigarette smoker	1.37 (0.65. 2.88)	0.41
ACEI or ARB	1.39 (0.84. 2.31)	0.20
Aspirin	1.35 (0.81. 2.25)	0.25
Beta blocker	1.15 (0.69. 1.89)	0.60
Calcium channel blocker	0.88 (0.52. 1.49)	0.62
Statin	0.99 (0.60. 1.64)	0.97
LV mass (g)	1.02 (1.01. 1.03)	0.001	1.01 (0.99. 1.02)	0.41
LV ejection fraction (per 10%)	0.75 (0.65. 0.86)	<0.001	0.84 (0.70. 0.99)	0.04
Myocardial ischemia	3.10 (1.86. 5.18)	<0.001	2.26 (1.23. 4.14)	0.01
Late gadolinium enhancement	2.30 (1.27. 4.19)	0.01	1.08 (0.55. 2.12)	0.8
Elevated PWV (>13.98 m/s)	1.75 (1.05. 2.94)	0.03	1.99 (1.17. 3.40)	0.01

	Global 𝛘²	Increase in 𝛘²	p-value
Clinical	10.19	–	–
Clinical + LVEF	27.11	14.17	<0.001
Clinical + LVEF + Myocardial ischemia	38.55	10.02	0.01
Clinical + LVEF + Myocardial ischemia + PWV	45.21	7.25	0.01

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[1] Mailing Address: Thananya Boonyasirinant • Division of Cardiology, Department of Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand – 2 Wanglang Rd. Bangkoknoi Bangkok 10700 – Thailand E-mail: DRTHANANYAA@YAHOO.COM