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Adenosine perfusion cardiac magnetic resonance imaging (CMR) provides good short-term prognostic information in patients with stable coronary artery disease. However, this has been proven mainly in selected patient populations and thus, cannot be directly transferred to the broad day-to-day clinical routine. Aim of our prospective study was to determine the incremental long-term prognostic value of a reversible perfusion deficit detected by CMR in a large, consecutive patient cohort with stable angina pectoris.
Consecutive patients referred for adenosine CMR exhibiting symptoms concordant with stable angina pectoris were screened for enrollment. All patients underwent adenosine perfusion (140 µg/kg/min) and late gadolinium enhancement imaging on a 1.5 T whole-body CMR scanner. A reversible perfusion deficit was defined as hypoperfusion during adenosine without concordant late gadolinium enhancement. The combined primary endpoint was defined as cardiac death, non-fatal myocardial infarction and stroke.
The study population consisted of 1,229 consecutive patients with low to high risk for a coronary artery disease. During the follow-up period of 4.2 ± 2.1 years, 88 primary endpoints happened. The probability for the occurrence of cardiac death or non-fatal myocardial infarction was significantly higher in patients with a reversible perfusion deficit (29 (9.4%) vs. 17 (2.0%), p < 0.0001 and 18 (5.8%) vs. 15 (1.8%), p < 0.001 resp.) than in patients without. On multivariate testing, the presence of a reversible perfusion deficit revealed to be the strongest independent risk factor for an adverse event with a 3-fold increased risk (Hazard ratio 2.99). Absence of a perfusion deficit was associated with a high negative predictive value of 95.6 % during follow-up.
Incremental over other conventional risk factors, adenosine perfusion CMR is a good risk stratification tool which provides long-term prognostic information in patients with stable coronary heart disease.
Oral Contributions South, Room 104
Saturday, March 09, 2013, 8:45 a.m.-9:00 a.m.
Session Title: Cardiac MRI in CAD: Acute and Chronic Applications, Prognosis and Safety
Abstract Category: 19. Imaging: MRI
Presentation Number: 907-6
- 2013 American College of Cardiology Foundation