Prognostic and therapeutic implications of dipyridamole stress cardiovascular magnetic resonance on the basis of the ischaemic cascade.
OBJECTIVE
To determine the prognostic and therapeutic implications of stress perfusion cardiovascular magnetic resonance (CMR) on the basis of the ischaemic cascade.


METHODS
Single centre study in a teaching hospital in Spain.


METHODS
Dipyridamole stress CMR was performed on 601 patients with ischaemic chest pain and known or suspected coronary artery disease. On the basis of the ischaemic cascade, patients were categorised in C1 (no evidence of ischaemia, n = 354), C2 (isolated perfusion deficit at stress first-pass perfusion imaging, n = 181) and C3 (simultaneous perfusion deficit and inducible wall motion abnormalities, n = 66). CMR-related revascularisation (n = 102, 17%) was defined as the procedure prompted by the CMR results and carried out within the next three months.


RESULTS
During a median follow-up of 553 days, 69 major adverse cardiac events (MACE), including 21 cardiac deaths, 14 non-fatal myocardial infarctions and 34 admissions for unstable angina with documented abnormal angiography were detected. In non-revascularised patients (n = 499), the MACE rate was 4% (14/340) in C1, 20% (26/128) in C2 and 39% (12/31) in C3 (adjusted p value = 0.004 vs C2 and <0.001 vs C1). CMR-related revascularisation had neutral effects in C2 (20% vs 19%, 1.1 (0.5 to 2.4), p = 0.7) but independently reduced the risk of MACE in C3 (39% vs 11%, 0.2 (0.1 to 0.7), p = 0.01).


CONCLUSIONS
Dypiridamole stress CMR is able to stratify risk on the basis of the ischaemic cascade. A small group of patients with severe ischaemia-simultaneous perfusion deficit and inducible wall motion abnormalities-are at the highest risk and benefit most from MACE reduction due to revascularisation.
Bodi
V
V
Cardiology Department, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain. vicentbodi@hotmail.com
Sanchis
J
J
Lopez-Lereu
M P
MP
Nunez
J
J
Mainar
L
L
Monmeneu
J V
JV
Ruiz
V
V
Rumiz
E
E
Husser
O
O
Moratal
D
D
Millet
J
J
Chorro
F J
FJ
Llacer
A
A
D002637:Chest Pain / Q000209:etiology*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004176:Dipyridamole; D005080:Exercise Test; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D055420:Perfusion Imaging / Q000379:methods; D011379:Prognosis; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole