TY - JOUR
T1 - Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population
AU - Bertaso, AG
AU - Richardson, JD
AU - Wong, DT
AU - Cunnington, MS
AU - Nelson, AJ
AU - Tayeb, H
AU - Williams, K
AU - Chew, Derek
AU - Worthley, Matthew
AU - Teo, Karen
AU - Worthley, Stephen
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Background: The high diagnostic accuracy of adenosine stress cardiac magnetic resonance (AS-CMR) for detecting coronary artery stenoses, with high sensitivity and specificity, is well documented. Prognostic data, particularly in non-low risk study populations and for greater than 12 months of follow up, is however lacking or variable in its findings. We present prognostic data, in an intermediate cardiovascular risk cohort undergoing adenosine stress perfusion CMR, over approximately 2 years of follow up. Methods: The study population comprised 362 patients referred for a clinically indicated stress CMR and included patients with proven coronary artery disease (CAD; n = 157) or unknown CAD status, yet an intermediate cardiovascular risk profile (n = 205). Perfusion imaging was performed at stress (adenosine 140 μg/kg/min) and rest on a 1.5 T system. Patient records and state-wide hospital databases were reviewed. Major adverse cardiac events - death, myocardial infarction, revascularisation or ischaemic hospitalisation - were evaluated over a median follow up of 22 months. Results: Of the 362 cases, 90 had a stress perfusion CMR positive for ischaemia and experienced a MACE rate of 24%. Of the 272 negative CMR scans, 225 were also negative for late gadolinium enhancement, and in this group MACE was encountered in only 6 (2.7%) patients. Accordingly a negative stress CMR afforded a freedom from MACE of 97.3%. Freedom from death/myocardial infarction was 99.6%. Conclusions: In patients with confirmed coronary artery disease or at intermediate risk for cardiovascular events, a negative stress perfusion CMR is associated with an excellent prognosis over nearly 2 years of follow up.
AB - Background: The high diagnostic accuracy of adenosine stress cardiac magnetic resonance (AS-CMR) for detecting coronary artery stenoses, with high sensitivity and specificity, is well documented. Prognostic data, particularly in non-low risk study populations and for greater than 12 months of follow up, is however lacking or variable in its findings. We present prognostic data, in an intermediate cardiovascular risk cohort undergoing adenosine stress perfusion CMR, over approximately 2 years of follow up. Methods: The study population comprised 362 patients referred for a clinically indicated stress CMR and included patients with proven coronary artery disease (CAD; n = 157) or unknown CAD status, yet an intermediate cardiovascular risk profile (n = 205). Perfusion imaging was performed at stress (adenosine 140 μg/kg/min) and rest on a 1.5 T system. Patient records and state-wide hospital databases were reviewed. Major adverse cardiac events - death, myocardial infarction, revascularisation or ischaemic hospitalisation - were evaluated over a median follow up of 22 months. Results: Of the 362 cases, 90 had a stress perfusion CMR positive for ischaemia and experienced a MACE rate of 24%. Of the 272 negative CMR scans, 225 were also negative for late gadolinium enhancement, and in this group MACE was encountered in only 6 (2.7%) patients. Accordingly a negative stress CMR afforded a freedom from MACE of 97.3%. Freedom from death/myocardial infarction was 99.6%. Conclusions: In patients with confirmed coronary artery disease or at intermediate risk for cardiovascular events, a negative stress perfusion CMR is associated with an excellent prognosis over nearly 2 years of follow up.
KW - Adenosine
KW - Cardiac magnetic resonance
KW - Intermediate risk
KW - Ischaemia
KW - Prognosis
KW - Stress perfusion
UR - http://www.scopus.com/inward/record.url?scp=84883269882&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2012.05.051
DO - 10.1016/j.ijcard.2012.05.051
M3 - Article
SN - 0167-5273
VL - 167
SP - 2055
EP - 2060
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 5
ER -