Complementary prognostic values of stress myocardial perfusion and late gadolinium enhancement imaging by cardiac magnetic resonance in patients with known or suspected coronary artery disease.
BACKGROUND
Recent studies have demonstrated the significant prognostic value of stress cardiac magnetic resonance (CMR) myocardial perfusion imaging. Apart from characterizing reversible perfusion defect (RevPD) from flow-limiting coronary stenosis, CMR late gadolinium enhancement (LGE) imaging is currently the most sensitive method for detecting subendocardial infarction (MI). We therefore tested the hypothesis that characterization of these 2 processes from coronary artery disease by CMR can provide complementary prognostic values.


RESULTS
We performed CMR myocardial perfusion imaging followed by LGE imaging on 254 patients referred with symptoms of myocardial ischemia. At a median follow-up of 17 months, 49 cardiac events occurred, including 12 cardiac deaths, 16 acute MIs, and 21 cardiac hospitalizations. RevPD and LGE both maintained a >3-fold association with cardiac death or acute MI (death/MI) when adjusted for each other and for the effects of patient age and gender (adjusted hazard ratio, 3.31; P=0.02; and hazard ratio, 3.43; P=0.01, respectively). In patients without a history of MI who had negative RevPD, LGE presence was associated with a >11-fold hazards increase in death/MI. Patients with neither RevPD nor LGE had a 98.1% negative annual event rate for death/MI. For association with major adverse cardiac events, RevPD was the strongest multivariable variable in the best overall model (hazard ratio, 10.92; P<0.0001).


CONCLUSIONS
CMR imaging provides robust risk stratification for patients who present with symptoms of ischemia. Characterization of RevPD and LGE by CMR provides strong and complementary prognostic implication for cardiac death or acute MI.
Steel
Kevin
K
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
Broderick
Ryan
R
Gandla
Vijay
V
Larose
Eric
E
Resnic
Frederick
F
Jerosch-Herold
Michael
M
Brown
Kenneth A
KA
Kwong
Raymond Y
RY
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D000789:Angina, Unstable / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D011859:Radiography