Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population.
BACKGROUND
The high diagnostic accuracy of adenosine stress cardiac magnetic resonance (AS-CMR) for detecting coronary artery stenoses, with high sensitivity and specificity, is well documented. Prognostic data, particularly in non-low risk study populations and for greater than 12 months of follow up, is however lacking or variable in its findings. We present prognostic data, in an intermediate cardiovascular risk cohort undergoing adenosine stress perfusion CMR, over approximately 2 years of follow up.


METHODS
The study population comprised 362 patients referred for a clinically indicated stress CMR and included patients with proven coronary artery disease (CAD; n=157) or unknown CAD status, yet an intermediate cardiovascular risk profile (n=205). Perfusion imaging was performed at stress (adenosine 140 μg/kg/min) and rest on a 1.5 T system. Patient records and state-wide hospital databases were reviewed. Major adverse cardiac events--death, myocardial infarction, revascularisation or ischaemic hospitalisation--were evaluated over a median follow up of 22 months.


RESULTS
Of the 362 cases, 90 had a stress perfusion CMR positive for ischaemia and experienced a MACE rate of 24%. Of the 272 negative CMR scans, 225 were also negative for late gadolinium enhancement, and in this group MACE was encountered in only 6 (2.7%) patients. Accordingly a negative stress CMR afforded a freedom from MACE of 97.3%. Freedom from death/myocardial infarction was 99.6%.


CONCLUSIONS
In patients with confirmed coronary artery disease or at intermediate risk for cardiovascular events, a negative stress perfusion CMR is associated with an excellent prognosis over nearly 2 years of follow up.
Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, Australia.
Angela G
AG
Bertaso
James D
JD
Richardson
Dennis T L
DT
Wong
Michael S
MS
Cunnington
Adam J
AJ
Nelson
Hussam
H
Tayeb
Kerry
K
Williams
Derek P
DP
Chew
Matthew I
MI
Worthley
Karen S L
KS
Teo
Stephen G
SG
Worthley
D000241:Adenosine; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D015331:Cohort Studies; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
D005682:Gadolinium; D000241:Adenosine