title: Prognostic implications of dipyridamole cardiac MR imaging: a prospective multicenter registry.
abstract: OBJECTIVE
  To evaluate dipyridamole cardiac magnetic resonance (MR) imaging in the prediction of major events (MEs) in patients with ischemic chest pain in a large multicenter registry.
  
  
  METHODS
  Institutional ethics committee approval and written informed consent were obtained. A total of 1722 patients who were undergoing cardiac MR imaging for chest pain were included. Wall motion abnormalities (WMAs) at rest, hyperemia perfusion defect (PD), late gadolinium enhancement (LGE), and inducible WMA were analyzed (abnormal if more than one abnormal segment was seen) with the 17-segment model. A cardiac MR categorization was created: category 1, no PD, LGE, or inducible WMA; category 2, PD without LGE and inducible WMA; category 3, LGE without inducible WMA; and category 4, inducible WMA. The association with ME was analyzed by using Cox proportional hazard regression multivariate models.
  
  
  RESULTS
  During a median follow-up period of 308 days, 61 MEs (4%) occurred (36 cardiac deaths, 25 nonfatal myocardial infarctions). MEs were associated with a greater extent of WMA, PD, LGE, and inducible WMA (P ≤ .001 for all analyses). In multivariable analyses, PD (P = .002) and inducible WMA (P = .0001) were the only cardiac MR predictors. ME rate in categories 1, 2, 3, and 4 was 2% (14 of 901 patients), 3% (six of 219 patients), 4% (15 of 409 patients), and 14% (26 of 193 patients), respectively (category 4 vs category 1, adjusted P < .001). Cardiac MR-directed revascularization was performed in 242 patients (14%) and reduced the risk of ME in only category 4 (7% [six of 92 patients] vs 26% [26 of 101 patients], P = .0004).
  
  
  CONCLUSIONS
  Dipyridamole cardiac MR imaging can be used to predict MEs in patients with ischemic chest pain. Patients with inducible WMA are at the highest risk for MEs and benefit the most from revascularization.
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Blasco Ibáñez 17, Valencia 46010, Spain. vicentbodi@hotmail.com
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodi
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: José V
authors.initials: JV
authors.lastname: Monmeneu
authors.forename: María P
authors.initials: MP
authors.lastname: López-Lereu
authors.forename: María J
authors.initials: MJ
authors.lastname: Bosch
authors.forename: Eva
authors.initials: E
authors.lastname: Rumiz
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Carlos
authors.initials: C
authors.lastname: García
authors.forename: José L
authors.initials: JL
authors.lastname: Diago
authors.forename: Fabián
authors.initials: F
authors.lastname: Chaustre
authors.forename: David
authors.initials: D
authors.lastname: Moratal
authors.forename: Cristina
authors.initials: C
authors.lastname: Gómez
authors.forename: José
authors.initials: J
authors.lastname: Aguilar
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llacer
mesh_terms: D000368:Aged; D016477:Artifacts; D016022:Case-Control Studies; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D003287:Contrast Media; D004176:Dipyridamole; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D004176:Dipyridamole