title: Ischemic burden and clinical outcome: is one 'culprit' ischemic segment by dobutamine stress magnetic resonance predictive?
abstract: OBJECTIVE
  We sought to evaluate the impact of ischemic burden for the prediction of hard cardiac events (cardiac death or nonfatal myocardial infarction) in patients with known or suspected CAD who undergo dobutamine stress cardiac magnetic resonance imaging (DCMR).
  
  
  METHODS
  We included 3166 patients (pts.), mean age 63 ± 12 years, 27% female, who underwent DCMR in 3 tertiary cardiac centres (University Hospital Heildelberg, German Heart Institute and Kings College London). Pts. were separated in groups based on the number of ischemic segments by wall motion abnormalities (WMA) as follows: 1. no ischemic segment, 2. one ischemic segment, 3. two ischemic segments and 4. ≥ three ischemic segments. Cardiac death and nonfatal myocardial infarction were registered as hard cardiac events. Pts. with an "early" revascularization procedure (in the first three months after DCMR) were not included in the final survival analysis.
  
  
  RESULTS
  Pts. were followed for a median of 3.1 years (iqr 2-4.5 years). 187 (5.9%) pts. experienced hard cardiac events. 2349 (74.2%) had no inducible ischemia, 189 (6%) had ischemia in 1 segment, 292 (9.2%) in 2 segments and 336 (10.6%) ≥ 3 segments. Patients with only 1 ischemic segment showed a high rate of hard cardiac events of ∼ 6% annually, which was 10-fold higher compared to those without ischemia (0.6% annually, p < 0.001) but similar to those with 2 and ≥ 3 ischemic segments (∼ 5.5% and ∼ 7%, p = NS).
  
  
  CONCLUSIONS
  The presence of inducible ischemia even in a single 'culprit' myocardial segment during DCMR is enough to predict hard cardiac events in patients with known or suspected CAD.
authors.affiliation: University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
authors.forename: Sorin
authors.initials: S
authors.lastname: Giusca
authors.affiliation: German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.affiliation: King's College London, Division of Imaging Sciences, London, United Kingdom.
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.affiliation: University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
authors.forename: Sebastian Johannes
authors.initials: SJ
authors.lastname: Buss
authors.affiliation: King's College London, Division of Imaging Sciences, London, United Kingdom.
authors.forename: Valentina
authors.initials: V
authors.lastname: Puntmann
authors.affiliation: German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Wellnhofer
authors.affiliation: German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.affiliation: University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
authors.forename: Hugo Albert
authors.initials: HA
authors.lastname: Katus
authors.affiliation: University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Korosoglou
mesh_terms: D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004280:Dobutamine / Q000008:administration & dosage*; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008131:London; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine