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

AIMS: Benefits of screening coronary artery disease (CAD) using stress perfusion cardiovascular magnetic resonance (CMR) in patients with hypertension without known CAD is not well established. The aim of our study was to assess the long-term prognostic value of vasodilator stress CMR in patients with hypertension without known CAD. METHODS AND RESULTS: Between December 2008 and January 2022, all consecutive patients with hypertension without known CAD referred for stress CMR were followed up to the occurrence of major cardiovascular events (MACE), defined as cardiovascular mortality or non-fatal myocardial infarction (MI). Cox regressions were performed to determine the prognostic value of each parameter. Among 2019 patients (69 ± 12 years; 45% male) with a median follow up of 6.7 (5.9-8.9) years, 327 had MACE (16%). Patients without ischaemia experienced a lower rate of MACE than those with ischaemia (12% vs. 39%, respectively, P < 0.001). Ischaemia and unrecognized MI were both significantly associated with the occurrence of MACE (respectively, HR: 4.1, 99.5% CI: 3.0-5.7 and HR: 3.6, 99.5% CI: 2.6-5.1, both P < 0.001). After adjustment, both the extent of ischaemia and unrecognized MI were independent predictors of MACE (respectively, HR: 1.2, 99.5% CI: 1.2-1.3, and HR: 1.2, 99.5% CI: 1.1-1.3, both P < 0.001). Adding stress CMR parameters improved model discrimination and reclassification, with greatest improvements in stepwise Model (C-statistic improvement: 0.02; net reclassification improvement: 0.50; integrative discrimination index: 0.02; all P < 0.001). CONCLUSION: In patients with hypertension without known CAD, stress CMR is a long-term predictor for the incidence of MACE and offer an incremental prognostic value over traditional predictors.