Prognostic value of global MR myocardial perfusion imaging in women with suspected myocardial ischemia and no obstructive coronary disease: results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study.
OBJECTIVE
The purpose of this study was to assess the prognostic value of global magnetic resonance (MR) myocardial perfusion imaging (MPI) in women with suspected myocardial ischemia and no obstructive (stenosis <50%) coronary artery disease (CAD).


BACKGROUND
The prognostic value of global MR-MPI in women without obstructive CAD remains unknown.


METHODS
Women (n = 100, mean age 57 ± 11 years, age range 31 to 76 years), with symptoms of myocardial ischemia and with no obstructive CAD, as assessed by coronary angiography, underwent MR-MPI and standard functional assessment. During follow-up (34 ± 16 months), time to first adverse event (death, myocardial infarction, or hospitalization for worsening anginal symptoms) was analyzed using global MPI and left ventricular ejection fraction (EF) data.


RESULTS
Adverse events occurred in 23 (23%) women. Using univariable Cox proportional hazards regression modeling, variables found to be predictive of adverse events were global MR-MPI average uptake slope (p < 0.05), the ratio of MR-MPI peak signal amplitude to uptake slope (p < 0.05), and EF (p < 0.05). Two multivariable Cox models were formed, 1 using variables that were performance site dependent: ratio of MR-MPI peak amplitude to uptake slope together with EF (chi square: 13, p < 0.005); and a model using variables that were performance site independent: MR-MPI slope and EF (chi square: 12, p < 0.005). Each of the 2 multivariable models remained predictive of adverse events after adjustment for age, disease history, and Framingham risk score. For each of the Cox models, patients were categorized as high risk if they were in the upper quartile of the model and as not high risk otherwise. Kaplan-Meier analysis of time to event was performed for high risk versus not high risk for site-dependent (log rank: 15.2, p < 0.001) and site-independent (log rank: 13.0, p < 001) models.


CONCLUSIONS
Among women with suspected myocardial ischemia and no obstructive CAD, MR-MPI-determined global measurements of normalized uptake slope and peak signal uptake, together with global functional assessment of EF, appear to predict prognosis.
Doyle
Mark
M
Division of Cardiology, CV MRI Center, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212-4772, USA. mdoyle@wpahs.org
Weinberg
Nicole
N
Pohost
Gerald M
GM
Bairey Merz
C Noel
CN
Shaw
Leslee J
LJ
Sopko
George
G
Fuisz
Anthon
A
Rogers
William J
WJ
Walsh
Edward G
EG
Johnson
B Delia
BD
Sharaf
Barry L
BL
Pepine
Carl J
CJ
Mankad
Sunil
S
Reis
Steven E
SE
Vido
Diane A
DA
Rayarao
Geetha
G
Bittner
Vera
V
Tauxe
Lindsey
L
Olson
Marian B
MB
Kelsey
Sheryl F
SF
Biederman
Robert W W
RW
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left