title: [Is stress cardiovascular magnetic resonance really useful to detect ischemia and predict events in patients with different cardiovascular risk profile?]
abstract: OBJECTIVE
  The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions.
  
  
  METHODS
  We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model.
  
  
  RESULTS
  295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p=0.001) or mild hypoperfusion (p=0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR=2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR=0.93; IC 95% 0.38-2.28).
  
  
  CONCLUSIONS
  Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions.
authors.affiliation: Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, España. Electronic address: athalbertus@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Esteban-Fernández
authors.affiliation: Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Isabel
authors.initials: I
authors.lastname: Coma-Canella
authors.affiliation: Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Gorka
authors.initials: G
authors.lastname: Bastarrika
authors.affiliation: Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Barba-Cosials
authors.affiliation: Servicio de Cardiología, Hospital San Pedro, Logroño, España.
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Azcárate-Agüero
mesh_terms: D057791:Cardiac Imaging Techniques; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cardiorresonancia magnética de estrés; Cardiovascular risk; Cociente de probabilidad; España; Isquemia miocárdica; Likelihood ratio; Myocardial ischemia; Prognosis; Pronóstico; Riesgo cardiovascular; Spain; Stress cardiovascular magnetic resonance