Abstract 3778: Combining First-pass Perfusion and Cine Wall Motion Assessment by Cardiac Magnetic Resonance During High-Dose Dobutamine Stress Provides Strong Association with Long-Term Patient Prognosis from Coronary Artery Disease
Background: Assessment of myocardial perfusion and regional function during dobutamine cardiac MRI (CMR) can characterize the cascade of demand ischemia. We tested the hypothesis that ischemia by perfusion (PERF) or regional function (CINE) by dobutamine CMR can provide independent prognostic association with adverse cardiac events (MACE) in patients.
Method: 114 patients (74 M, age 60±14 years) with suspected ischemia underwent dobutamine stress CMR with combined perfusion and cine imaging. Logistic regression assessed the association with subsequent diagnosis of significant (>70%) coronary stenosis (CATHCAD) or MACE at 12 months after CMR. CATHCAD within 1 month after CMR was excluded to minimize the impact by CMR on angiographic referral. We also performed Cox regression to model the event-free survival of patients in the follow-up period.
Results: At 12 months after CMR, 28 patients were diagnosed to have CATHCAD and 8 experienced MACE. At study end, 25 patients experienced MACE including 13 deaths. For new CATHCAD within 12 months after CMR, CINE, PERF, and combined CINE/PERF had sensitivities of 75%, 96%, and 96%, and specificities of 86%, 71%, and 58%, respectively. By multivariable logistic regression, CINE and PERF provided independent and complementary association with CATHCAD or MACE at 12 months after CMR (adjusted OR: 7.33, p=0.001 and 4.18, p=0.02, respectively). Abnormal CINE and PERF were both associated with reduced event-free survival over the study period (median 18 months, range 6 – 48) (Figure 1⇓).
Conclusion: CINE and PERF provide complementary assessment of coronary artery disease and long-term patient prognosis.