title: Gender-based prognostic value of pharmacological cardiac magnetic resonance stress testing: head-to-head comparison of adenosine perfusion and dobutamine wall motion imaging.
abstract: This study evaluated the gender related long-term prognostic value of adenosine perfusion and dobutamine wall motion imaging as assessed during a combined single-session stress cardiac magnetic resonance (CMR) examination. In 717 patients a combined CMR stress examination was performed. Inducible perfusion deficits and wall motion abnormalities were identified visually. Clinical parameters were assessed at the time of the CMR examination. All patients were contacted to determine the occurrence of hard cardiac events (cardiac death, myocardial infarction) during a median follow-up period of 5.3 years. A complete combined CMR examination and follow-up data were available in 679 patients (471 men). A total of 77 hard cardiac events (63 in men) occurred during follow-up. Multivariate analysis revealed the presence of inducible perfusion deficits or wall motion abnormalities as independent predictors of hard cardiac events for both gender with an incremental value over conventional cardiovascular risk factors. In case of a negative stress test result, event-free survival was 100% in women for 4 years and >99% in men for 2 years after the CMR examination. CMR perfusion and wall motion testing are equally suited for cardiac risk stratification in men and women. Stress CMR negative women exhibited very low event rates up to 4 years following the examination, while in men annual event rates increased after the second year. Consequently, the generally proposed 2-year warranty period of non-invasive stress testing may be prolonged to a 4 year level in CMR stress testing negative women.
authors: Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. cjahnke@alice.de
authors: Cosima
authors: C
authors: Jahnke
authors: Vesna
authors: V
authors: Furundzija
authors: Rolf
authors: R
authors: Gebker
authors: Robert
authors: R
authors: Manka
authors: Michael
authors: M
authors: Frick
authors: Bernhard
authors: B
authors: Schnackenburg
authors: Nikolaus
authors: N
authors: Marx
authors: Ingo
authors: I
authors: Paetsch
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D003326:Coronary Circulation; D018450:Disease Progression; D018572:Disease-Free Survival; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000401:mortality; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
chemical_list: D004280:Dobutamine; D000241:Adenosine