title: Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This study sought to perform a systematic review and meta-analysis to understand the role of stress cardiac magnetic resonance imaging (CMR) in assessing cardiovascular prognosis in patients with known or suspected coronary artery disease (CAD).
  
  
  BACKGROUND
  Although stress CMR is excellent for the diagnosis of obstructive CAD, the prognostic value of stress CMR has been less well described.
  
  
  METHODS
  PubMed, Cochrane CENTRAL, and metaRegister of Controlled Trials were searched for stress CMR studies with >6 months of prognostic data. Primary endpoints were cardiovascular death, myocardial infarction (MI), and a composite outcome of cardiovascular death or MI during follow-up. Summary effect estimates were generated with random-effects modeling, and annualized event rates were assessed.
  
  
  RESULTS
  Nineteen studies (14 vasodilator, 4 dobutamine, and 1 that used both) involved a total of 11,636 patients with a mean follow-up of 32 months. Patients had a mean age of 63 ± 12 years, 63% were male, and 26% had previous MI; mean left ventricular ejection fraction was 61 ± 12%; and late gadolinium enhancement was present in 29% and ischemia in 32%. Patients with ischemia had a higher incidence of MI (odds ratio [OR]: 7.7; p < 0.0001), cardiovascular death (OR: 7.0; p < 0.0001), and the combined endpoint (OR: 6.5; p < 0.0001) compared with those with a negative study. The combined outcome annualized events rates were 4.9% for a positive versus 0.8% for a negative stress CMR (p < 0.0001), 2.8% versus 0.3% for cardiovascular death (p < 0.0001), and 2.6% versus 0.4% for MI (p < 0.0005). The presence of late gadolinium enhancement was also significantly associated with a worse prognosis.
  
  
  CONCLUSIONS
  A negative stress CMR study is associated with very low risk of cardiovascular death and MI. Stress CMR has excellent prognostic characteristics and may help guide risk stratification of patients with known or suspected CAD.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.forename: Courtney M
authors.initials: CM
authors.lastname: McVey
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berger
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.forename: Michael
authors.initials: M
authors.lastname: Salerno
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D018570:Risk Assessment
chemical_list: D005682:Gadolinium
keywords: AER; CAD; CMR; LGE; MACE; MI; OR; annualized event rate; cardiac magnetic resonance imaging; coronary artery disease; late gadolinium enhancement; major adverse cardiovascular event(s); myocardial infarction; myocardial perfusion; odds ratio; prognosis; stress cardiac MRI