Abstract 407: Stress Myocardial Perfusion Imaging by Cardiac Magnetic Resonance Provides Accurate Detection of Coronary Artery Disease and Strong Prognostic Value to Hard Cardiac Events Regardless of Patient’s Gender
Background Noninvasive detection of CAD in women is often limited by soft tissue attenuation and limits in spatial resolution. CMR perfusion imaging (CMRPI) may characterize evidence of flow limiting CAD at high resolution and tissue contrast. We therefore sought to test the hypothesis that CMRPI can detect CAD and provide robust prognostication in women as well as in men.
Methods/Results CMRPI was performed on 424 patients (177 women, mean age 57±13 years) referred for assessment of ischemia. Rest and vasodilator stress CMRPI were performed using 0.05– 0.1mmol/Kg of gadolinium bolus, followed by late gadolinium enhancement (LGE) and cine imaging. At a median follow up of 30 months, 38 major events (MACE) (9%) occurred (27 cardiac deaths and 11 acute MI), among these 11 cardiac deaths and 5 acute MI were women. By univariable analysis, a presence of reversible perfusion defect (RevPD) portended to >6 fold increase in MACE hazards in both women (HR=6.13, P=0.0003) and men (HR=6.08, P=0.0002). A CMR absent in RevPD and LGE indicated low annual rates of cardiac death (1.1, 1.9%) and MACE (1.8, 1.4%), respectively in women and men (Fig 1⇓). Adjusting for age, LVEF, RevPD maintains strong adjusted association with MACE in either gender (adjusted HR 4.19 and 3.42, P=0.009 and 0.002 for women and men, respectively). In women, RevPD was the strongest multivariable predictor for MACE. For diagnosis of CAD, RevPD detected all patients with ≥ 2 coronary stenoses on subsequent angiography in either gender.
Conclusion CMRPI provides robust prognostication for cardiac events in both women and men. A CMR study negative for both RevPD and LGE indicates low event rates for MACE or cardiac death in either gender.