title: Incremental value of normal adenosine perfusion cardiac magnetic resonance: Long-term outcome.
abstract: BACKGROUND
  The purpose of the study was to determine the long-term prognostic value of normal adenosine stress cardiac magnetic resonance imaging (CMR) in patients referred for evaluation of myocardial ischemia.
  
  
  METHODS
  We reviewed 300 consecutive patients (age 65 ± 11 years, 74% male) with suspected or known coronary disease and normal wall motion who had undergone adenosine stress CMR negative for ischemia and scar. Most patients were at intermediate risk of coronary artery disease. The end points studied were all causes of mortality and major adverse cardiac events, including cardiac death, myocardial infarction, revascularization, and hospitalization for unstable angina.
  
  
  RESULTS
  During a mean follow-up of 5.5 years (mean = 5.4 ± 1.1), 16 patients died because of various causes (cardiac death in 5 patients). Three patients had a nonfatal myocardial infarction, 7 patients were hospitalized for revascularization, and 11 were medically treated for unstable angina. The annual cardiac event rate was 1.3% (0.78% in the first 3 years and 1.9% between the fourth and sixth years). The predictors of major adverse cardiac events in a multivariate analysis model were as follows: advanced age (hazard ratio [HR] 1.15, 95% confidence interval [95% CI] 1.02-1.30), diabetes (HR 17.5, 95% CI 2.2-140), and the habit of smoking (HR 5.9, 95% CI 1.0-35.5). For all causes of mortality, the only predictor was diabetes (HR 11.4, 95% CI 1.76-74.2). Patients with normal stress CMR had an excellent outcome during the 3 years after the study. The cardiac event rate was higher between the fourth and sixth years.
  
  
  CONCLUSIONS
  Over a 5.5-year period, a low event rate and excellent prognosis occurred in patients with normal adenosine stress CMR. Low- to intermediate-risk patients with a normal CMR are at low risk for subsequent cardiac events.
authors.affiliation: Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, IT. Electronic address: fabiola_sozzi@yahoo.it.
authors.forename: Fabiola B
authors.initials: FB
authors.lastname: Sozzi
authors.affiliation: Monaco Cardiothoracic Centre, Monaco, MC.
authors.forename: Laura
authors.initials: L
authors.lastname: Iacuzio
authors.affiliation: Monaco Cardiothoracic Centre, Monaco, MC.
authors.forename: Filippo
authors.initials: F
authors.lastname: Civaia
authors.affiliation: Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, IT.
authors.forename: Ciro
authors.initials: C
authors.lastname: Canetta
authors.affiliation: Monaco Cardiothoracic Centre, Monaco, MC.
authors.forename: Frederic
authors.initials: F
authors.lastname: Berthier
authors.affiliation: Monaco Cardiothoracic Centre, Monaco, MC.
authors.forename: Stephane
authors.initials: S
authors.lastname: Rusek
authors.affiliation: Monaco Cardiothoracic Centre, Monaco, MC.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rossi
authors.affiliation: Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, IT.
authors.forename: Federico
authors.initials: F
authors.lastname: Lombardi
authors.affiliation: Monaco Cardiothoracic Centre, Monaco, MC.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dreyfus
authors.affiliation: Monaco Cardiothoracic Centre, Monaco, MC.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dor
mesh_terms: D000241:Adenosine; D000368:Aged; D002423:Cause of Death; D003327:Coronary Disease / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D018570:Risk Assessment
chemical_list: D000241:Adenosine