title: Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex.
abstract: OBJECTIVE
  The major aim of this study is to test the hypothesis that stress cardiac magnetic resonance (CMR) imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men.
  
  
  BACKGROUND
  Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men owing to a lack of early diagnosis and management. Numerous clinical studies have shown that stress CMR detects evidence of myocardial ischemia and infarction at high accuracy. Compared to nuclear scintigraphy, CMR is free of ionizing radiation, has high spatial resolution for imaging small hearts, and overcomes breast attenuation artifacts, which are substantial advantages when imaging women for CAD.
  
  
  METHODS
  We performed stress CMR in 405 patients (168 women, mean age 58 ± 14 years) referred for ischemia assessment. CMR techniques included cine cardiac function, perfusion imaging during vasodilating stress, and late gadolinium enhancement imaging. All patients were followed for major adverse cardiac events (MACE).
  
  
  RESULTS
  At a median follow-up of 30 months, MACE occurred in 36 patients (9%) including 21 cardiac deaths and 15 acute myocardial infarctions. In women, CMR evidence of ischemia (ISCHEMIA) demonstrated strong association with MACE (unadjusted hazard ratio: 49.9, p < 0.0001). While women with ISCHEMIA(+) had an annual MACE rate of 15%, women with ISCHEMIA(-) had very low annual MACE rate (0.3%), which was not statistically different from the low annual MACE rate in men with ISCHEMIA(-) (1.1%). CMR myocardial ischemia score was the strongest multivariable predictor of MACE in this cohort, for both women and men, indicating robust cardiac prognostication regardless of sex.
  
  
  CONCLUSIONS
  In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Otavio R
authors.initials: OR
authors.lastname: Coelho-Filho
authors.forename: Luciana F
authors.initials: LF
authors.lastname: Seabra
authors.forename: François-Pierre
authors.initials: FP
authors.lastname: Mongeon
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Francis
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D018572:Disease-Free Survival; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / 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; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D019786:Gadolinium DTPA