PMID- 24726254 OWN - NLM STAT- MEDLINE DCOM- 20150106 LR - 20240213 IS - 1876-7591 (Electronic) IS - 1936-878X (Print) IS - 1876-7591 (Linking) VI - 7 IP - 5 DP - 2014 May TI - Vasodilator stress perfusion CMR imaging is feasible and prognostic in obese patients. PG - 462-72 LID - S1936-878X(14)00139-9 [pii] LID - 10.1016/j.jcmg.2013.11.011 [doi] AB - OBJECTIVES: This study sought to determine feasibility and prognostic performance of stress cardiac magnetic resonance (CMR) in obese patients (body mass index [BMI] >/=30 kg/m(2)). BACKGROUND: Current stress imaging methods remain limited in obese patients. Given the impact of the obesity epidemic on cardiovascular disease, alternative methods to effectively risk stratify obese patients are needed. METHODS: Consecutive patients with a BMI >/=30 kg/m(2) referred for vasodilating stress CMR were followed for major adverse cardiovascular events (MACE), defined as cardiac death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR beyond traditional clinical risk indexes. RESULTS: Of 285 obese patients, 272 (95%) completed the CMR protocol, and among these, 255 (94%) achieved diagnostic imaging quality. Mean BMI was 35.4 +/- 4.8 kg/m(2), with a maximum weight of 200 kg. Reasons for failure to complete CMR included claustrophobia (n = 4), intolerance to stress agent (n = 4), poor gating (n = 4), and declining participation (n = 1). Sedation was required in 19 patients (7%; 2 patients with intravenous sedation). Sixteen patients required scanning by a 70-cm-bore system (6%). Patients without inducible ischemia or LGE experienced a substantially lower annual rate of MACE (0.3% vs. 6.3% for those with ischemia and 6.7% for those with ischemia and LGE). Median follow-up of the cohort was 2.1 years. In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, inducible ischemia (hazard ratio 7.5; 95% confidence interval: 2.0 to 28.0; p = 0.002) remained independently associated with MACE. When patients with early coronary revascularization (within 90 days of CMR) were censored on the day of revascularization, both presence of inducible ischemia and ischemia extent per segment maintained a strong association with MACE. CONCLUSIONS: Stress CMR is feasible and effective in prognosticating obese patients, with a very low negative event rate in patients without ischemia or infarction. CI - Copyright (c) 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Shah, Ravi V AU - Shah RV AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Heydari, Bobak AU - Heydari B AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Coelho-Filho, Otavio AU - Coelho-Filho O AD - Cardiology Division, State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil. FAU - Abbasi, Siddique A AU - Abbasi SA AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Feng, Jiazhuo H AU - Feng JH AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Neilan, Tomas G AU - Neilan TG AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Francis, Sanjeev AU - Francis S AD - Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Blankstein, Ron AU - Blankstein R AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Steigner, Michael AU - Steigner M AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Jerosch-Herold, Michael AU - Jerosch-Herold M AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Kwong, Raymond Y AU - Kwong RY AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rykwong@partners.org. LA - eng GR - T32 HL094301/HL/NHLBI NIH HHS/United States GR - R01-HL091157/HL/NHLBI NIH HHS/United States GR - U01 HL084877/HL/NHLBI NIH HHS/United States GR - R01 HL091157/HL/NHLBI NIH HHS/United States GR - U01-HL084877/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20140409 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Vasodilator Agents) SB - IM CIN - JACC Cardiovasc Imaging. 2014 May;7(5):473-5. PMID: 24831207 MH - Body Mass Index MH - Feasibility Studies MH - Female MH - Follow-Up Studies MH - Humans MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Myocardial Ischemia/*diagnosis/etiology/physiopathology MH - Obesity/*complications MH - Prognosis MH - Retrospective Studies MH - *Vasodilator Agents PMC - PMC4110212 MID - NIHMS601190 OTO - NOTNLM OT - cardiac magnetic resonance OT - obesity OT - stress testing EDAT- 2014/04/15 06:00 MHDA- 2015/01/07 06:00 PMCR- 2014/07/24 CRDT- 2014/04/15 06:00 PHST- 2013/06/05 00:00 [received] PHST- 2013/11/14 00:00 [revised] PHST- 2013/11/22 00:00 [accepted] PHST- 2014/04/15 06:00 [entrez] PHST- 2014/04/15 06:00 [pubmed] PHST- 2015/01/07 06:00 [medline] PHST- 2014/07/24 00:00 [pmc-release] AID - S1936-878X(14)00139-9 [pii] AID - 10.1016/j.jcmg.2013.11.011 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2014 May;7(5):462-72. doi: 10.1016/j.jcmg.2013.11.011. Epub 2014 Apr 9.