title: The prognostic value of normal stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a meta-analysis.
abstract: BACKGROUND
  Ischemia detection with stress cardiac magnetic resonance (CMR) is typically based on induction of either myocardial perfusion defect or wall motion abnormality. Single-center studies have shown the high value of stress CMR for risk stratification. The aim of this study was to define the prognostic value of stress CMR for prediction of adverse cardiac events in patients with known or suspected coronary artery disease.
  
  
  RESULTS
  Studies published between January 1985 and April 2012 were identified by database search. We included studies using stress CMR to evaluate subjects with known or suspected coronary artery disease and providing primary data on clinical outcomes of nonfatal myocardial infarction or cardiac death with a follow-up time ≥3 months. Total of 14 studies were finally included, recruiting 12 178 patients. The negative predictive value for nonfatal myocardial infarction and cardiac death of normal CMR was 98.12% (95% confidence interval, 97.26-98.83) during a weighted mean follow-up of 25.3 months, resulting in estimated event rate after a negative test equal to 1.88% (95% confidence interval, 1.17-2.74). The corresponding annualized event rate after a negative test was 1.03%. Comparable negative predictive values for major coronary events were obtained in studies considering the absence of inducible perfusion defect compared with those evaluating the absence of inducible wall motion abnormality (98.39% versus 97.31%, respectively; P=0.227 by meta-regression analysis).
  
  
  CONCLUSIONS
  Stress CMR has a high negative predictive value for adverse cardiac events, and the absence of inducible perfusion defect or wall motion abnormality shows a similar ability to identify low-risk patients with known or suspected coronary artery disease.
authors.affiliation: SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gargiulo
authors.forename: Santo
authors.initials: S
authors.lastname: Dellegrottaglie
authors.forename: Dario
authors.initials: D
authors.lastname: Bruzzese
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.forename: Oriana
authors.initials: O
authors.lastname: Scala
authors.forename: Donatella
authors.initials: D
authors.lastname: Ruggiero
authors.forename: Carmen
authors.initials: C
authors.lastname: D'Amore
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolillo
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.forename: Edoardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Andrea
authors.initials: A
authors.lastname: Soricelli
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone Filardi
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents
keywords: cardiac magnetic resonance imaging; chronic ischemic heart disease; coronary artery disease; prognostic value