Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease.
OBJECTIVE
We evaluated the prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging (CMR) in patients with chest pain and known or suspected coronary artery disease.


BACKGROUND
Stress perfusion CMR has been incorporated in daily practice. Data on its prognostic value are preliminary.


METHODS
Dipyridamole stress CMR was performed in 420 patients with chest pain and known or suspected coronary artery disease. The extent (number of segments according to the 17-segment model) of abnormal wall motion at rest (AWM-rest), abnormal wall motion with dipyridamole (AWM-D), perfusion deficit (at stress first-pass perfusion imaging), and delayed enhancement (at late enhancement imaging) were analyzed.


RESULTS
During a median follow-up of 420 days, 41 major adverse cardiac events (MACE), including 9 cardiac deaths, 14 nonfatal myocardial infarctions, and 18 readmissions for unstable angina with documented abnormal angiography, were documented. The MACE were more frequent in patients with significant (>1 segment) AWM-rest (22% vs. 5%), AWM-D (21% vs. 4%), perfusion deficit (17% vs. 5%), and delayed enhancement (20% vs. 6%; p <0.0001 in all cases). In a multivariate analysis adjusted for baseline characteristics, the extent of AWM-D was independently related to MACE (hazard ratio [HR] 1.15 [95% confidence interval (CI) 1.06 to 1.24] per segment; p = 0.0006) and to major events (cardiac death or nonfatal myocardial infarction; HR 1.15 [95% CI 1.05 to 1.26] per segment; p = 0.002).


CONCLUSIONS
Dipyridamole stress CMR is useful for predicting the outcome of patients with known or suspected coronary artery disease.
Bodi
Vicente
V
Cardiology Department, University Clinic Hospital, University of Valencia, Valencia, Spain. vicentbodi@hotmail.com
Sanchis
Juan
J
Lopez-Lereu
Maria P
MP
Nunez
Julio
J
Mainar
Luis
L
Monmeneu
Jose V
JV
Husser
Oliver
O
Dominguez
Eloy
E
Chorro
Francisco J
FJ
Llacer
Angel
A
D000368:Aged; D002637:Chest Pain / Q000175:diagnosis; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis*; D004176:Dipyridamole; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D004176:Dipyridamole