Abstract 20093: Long Term Prognostic Value of Stress Perfusion CMR Study for the Prediction of Cardiovascular Death and Non Fatal Acute Myocardial Infarction in Patients with or without Preserved Left Ventricular Ejection Fraction
Background: LV ejection fraction (EF) is a powerful independent predictor of survival in patients with coronary artery disease (CAD). Furthermore, myocardial infarction by late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (CMR) and myocardial ischemia by stress perfusion CMR can also provide the prognostic value in patients with CAD. In this study, we determined the long term (up to 10 years) prognostic value of stress perfusion CMR study in a large number of CAD patients with or without preserved LVEF.
Methods: We studied 1020 patients (742 men, and mean age 67±10 years old) with known or suspected CAD who underwent Cine MRI, stress perfusion CMR and LGE CMR. Stress-induced ischemia on stress perfusion CMR and myocardial infarction on LGE CMR were qualitatively determined. MACE was defined as cardiovascular death and non fatal acute myocardial infarction.
Results: During average follow-up time of 40 months (range, 6 to 120 months), 59 patients (6%) reached MACE. Decreased LVEF (<50) predicted patients outcome with hazard ratio of 3.4 (95% CI 2.0–5.7, P<0.001) and presence of LGE predicted patients outcome with HR 2.0 (95% CI 1.2–3.5, P<0.01). Furthermore, stress perfusion CMR combined with LGE CMR was a significant negative prognostic factor of MACE with a high hazard ratio of 5.3(95% CI 2.4–12.2, P<0.001). And, even in patients with decreased LVEF, normal stress perfusion CMR and LGE CMR was associated with low event rate per year (0.7%) as well as in patients with preserved LVEF(≥50) (0.4%). On the other hand, in patients with decreased LVEF, any abnormality in stress perfusion CMR and LGE CMR provided a significant negative prognostic value with event rate per year 2.9% and HR of 7.5 (95% CI 1.1–54.6, P<0.05). (Figure1)
Conclusions: Negative stress perfusion CMR and LGE CMR studies showed good prognostic value even in patients with decreased LVEF. Cine MRI may provide the incremental prognostic value to stress perfusion CMR and LGE CMR.
- © 2010 by American Heart Association, Inc.