title: Prognostic value of myocardial ischemia and necrosis in depressed left ventricular function: a multicenter stress cardiac magnetic resonance registry.
abstract: OBJECTIVE
  The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance.
  
  
  METHODS
  In a multicenter registry using stress magnetic resonance, the presence (≥ 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined.
  
  
  RESULTS
  In 391 patients, perfusion defect or late enhancement were present in 224 (57%) and 237 (61%). During follow-up (median, 96 weeks), 47 major events (12%) occurred: 25 cardiac deaths and 22 myocardial infarctions. Patients with major events displayed a larger extent of perfusion defects (6 segments vs 3 segments; P <.001) but not late enhancement (5 segments vs 3 segments; P =.1). Major event rate was significantly higher in the presence of perfusion defects (17% vs 5%; P =.0005) but not of late enhancement (14% vs 9%; P =.1). Patients were categorized into 4 groups: absence of perfusion defect and absence of late enhancement (n = 124), presence of late enhancement and absence of perfusion defect (n = 43), presence of perfusion defect and presence of late enhancement (n = 195), absence of late enhancement and presence of perfusion defect (n = 29). Event rate was 5%, 7%, 16%, and 24%, respectively (P for trend = .003). In a multivariate regression model, only perfusion defect (hazard ratio = 2.86; 95% confidence interval, 1.37-5.95]; P = .002) but not late enhancement (hazard ratio = 1.70; 95% confidence interval, 0.90-3.22; P =.105) predicted events.
  
  
  CONCLUSIONS
  In depressed left ventricular function, the presence of inducible ischemia is the strongest predictor of major events.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.affiliation: ERESA, Valencia, Spain.
authors.forename: Jose V
authors.initials: JV
authors.lastname: Monmeneu
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.affiliation: ERESA, Valencia, Spain.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Lopez-Lereu
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Nuñez
authors.affiliation: Servicio de Cardiología, Hospital La Plana, Vila-real, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Bosch
authors.affiliation: Servicio de Cardiología, Hospital General de Castellón, Castellon, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Garcia
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain. Electronic address: vicentbodi@hotmail.com.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodi
mesh_terms: D000368:Aged; D057791:Cardiac Imaging Techniques; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis / Q000175:diagnosis; D011379:Prognosis; D012042:Registries; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis*
keywords: Depressed left ventricular function; Dipiridamol; Dipyridamole; Función ventricular izquierda deprimida; Prognosis; Pronóstico; Resonancia magnética cardiaca de estrés; Stress cardiac magnetic resonance imaging