Author + information
- Michael J. Lipinski,
- Courtney M. McVey,
- Jeffrey S. Berger,
- Christopher M. Kramer and
- Michael Salerno
While the diagnostic accuracy of stress cardiac magnetic resonance imaging (CMR) for detecting obstructive coronary artery disease (CAD) has been established, the prognostic value of stress CMR is less well described. Thus, we performed meta-analysis to understand the role of stress CMR in assessing cardiovascular prognosis.
PubMed, CENTRAL, and mRCT were searched for studies with greater than 6 months of prognostic data on patients that underwent stress CMR. Primary end-points were cardiovascular mortality, myocardial infarction (MI), and the combination of the two. Pooling with random-effect modeling generated summary effect estimates (95% confidence intervals) and annualized event rates were assessed.
Data was included from 19 studies with a total of 10,573 patients and a median follow-up of 24 months. Patients had a median age of 62 years, 59% were male, median LV ejection fraction was 60%, late gadolinium enhancement (LGE) was present in 21% of patients, and ischemia in 29% of patients. Studies demonstrated that patients with ischemia on stress CMR had significantly higher incidence of MI (OR 9.05, p<0.001), cardiovascular death (OR 8.09, p<0.001), and the combined endpoint (OR 6.82, p<0.001) as compared with those with a negative study. The combined outcome annualized events rates were 5.0% for a positive versus 0.8% for negative stress CMR(p<0.0001), 2.8% versus 0.3% for cardiovascular death (p<0.0001), and 2.8% versus 0.3% for MI (p<0.0004). Meta-regression analysis demonstrated that LGE on CMR (R-squared 0.63, p<0.004), prior MI (R-squared 0.48, p<0.006), older age (R-squared 0.23, p<0.04) were all associated with an increased incidence of combined cardiovascular outcomes. Patients with evidence of LGE had a worse combined outcome than patients without LGE (OR 3.82, p<0.001)
A negative stress CMR study (vasodilator or dobutamine) is associated with very low risk of cardiovascular mortality or MI. Thus, stress CMR has excellent prognostic characteristics comparable to stress echocardiography or nuclear imaging and may help guide risk stratification of patients presenting with known or suspected CAD.
Oral Contributions South, Room 104
Saturday, March 09, 2013, 9:00 a.m.-9:15 a.m.
Session Title: Cardiac MRI in CAD: Acute and Chronic Applications, Prognosis and Safety
Abstract Category: 19. Imaging: MRI
Presentation Number: 907-7
- 2013 American College of Cardiology Foundation