title: Risk stratification by regadenoson stress magnetic resonance imaging in patients with known or suspected coronary artery disease.
abstract: The aim of this study was to investigate the association between major adverse cardiovascular events (MACEs) and inducible ischemia on regadenoson cardiac magnetic resonance (CMR) myocardial perfusion imaging (MPI) performed at 3.0 T. Regadenoson stress CMR MPI is increasingly used to assess patients with suspected ischemia; however, its value in patient prognostication and risk reclassification is only emerging. A total of 346 patients with suspected ischemia who were referred for regadenoson CMR were studied. The prognostic association of presence of inducible ischemia by CMR with MACEs was determined. In addition, we assessed the extent of net reclassification improvement by CMR beyond a clinical risk model. There were 52 MACEs during a median follow-up period of 1.9 years. Patients with inducible ischemia were fourfold more likely to experience MACEs (hazard ratio, 4.14, 95% confidence interval 2.37 to 7.24, p <0.0001). In the best overall model, presence of inducible ischemia conferred a 2.6-fold increased hazard for MACEs adjusted to known clinical risk markers (adjusted hazard ratio 2.59, 95% confidence interval 1.30 to 5.18, p = 0.0069). Patients with no inducible ischemia experienced a low rate of cardiac death and myocardial infarction (0.6% per patient-year), whereas those with inducible ischemia had an annual event rate of 3.2%. Net reclassification improvement across risk categories (low <5%, intermediate 5% to 10%, and high >10%) by CMR was 0.29 (95% confidence interval 0.15 to 0.44), and continuous net reclassification improvement was 0.58. In conclusion, in patients with clinical suspicion of myocardial ischemia, regadenoson stress CMR MPI provides robust risk stratification. CMR MPI negative for ischemia was associated with a very low annual rate of hard cardiac events. In addition, CMR MPI provides effective risk reclassification in a substantial proportion of patients.
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Bobak
authors.initials: B
authors.lastname: Heydari
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ying Yi
authors.initials: YY
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Steigner
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.affiliation: Department of Medicine, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rykwong@partners.org.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology