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dc.contributor.authorunicampCoelho-Filho, Otávio Rizzi-
dc.titleVasodilator stress perfusion CMR imaging is feasible and prognostic in obese patientspt_BR
dc.contributor.authorShah, Ravi V.-
dc.contributor.authorHeydari, Bobak-
dc.contributor.authorCoelho-Filho, Otavio-
dc.contributor.authorAbbasi, Siddique A.-
dc.contributor.authorFeng, Jiazhuo H.-
dc.contributor.authorNeilan, Tomas G.-
dc.contributor.authorFrancis, Sanjeev-
dc.contributor.authorBlankstein, Ron-
dc.contributor.authorSteigner, Michael-
dc.contributor.authorJerosch-Herold, Michael-
dc.contributor.authorKwong, Raymond Y.-
dc.description.abstractObjectives This study sought to determine feasibility and prognostic performance of stress cardiac magnetic resonance (CMR) in obese patients (body mass index [BMI] ≥30 kg/m2). 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/m2 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/m2, 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 infarctionpt_BR
dc.relation.ispartofJACC: cardiovascular imagingpt_BR
dc.relation.ispartofabbreviationJACC cardiovasc. imagingpt_BR
dc.publisher.cityNew York, NYpt_BR
dc.publisher.countryEstados Unidospt_BR
dc.description.provenanceSubmitted by Sanches Olivia ( on 2020-12-23T18:40:22Z No. of bitstreams: 0. Added 1 bitstream(s) on 2021-02-25T19:55:39Z : No. of bitstreams: 1 2-s2.0-84900414192.pdf: 5475348 bytes, checksum: 2766c42dcff5369df1f2b0696e3fd142 (MD5)en
dc.description.provenanceMade available in DSpace on 2020-12-23T18:40:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2014en
dc.contributor.departmentsem informaçãopt_BR
dc.contributor.unidadeFaculdade de Ciências Médicaspt_BR
dc.subject.keywordCardiac magnetic resonancept_BR
dc.subject.keywordStress testingpt_BR
dc.type.formArtigo originalpt_BR
dc.description.otherSponsorshipsem informaçãopt_BR
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