Abstract 12593: Prognostic Value of Coronary Magnetic Resonance Angiography Compared to Left Ventricular Ejection Fraction and Late Gadolinium Enhancement

Abstract

Background The combination of coronary MR angiography (CMRA) with cine- and late gadolinium-enhanced (LGE)-MRI provides a comprehensive assessment of coronary artery disease (CAD). However, prognostic value of CMRA compared to cine- or LGE-MRI has not been evaluated. We sought to study the independent and incremental prognostic value of CMRA over clinical variables, left ventricular ejection fraction (LVEF), and presence of LGE.

Methods Cine-, LGE-MRI, and whole-heart CMRA were acquired by using 1.5T MR system and 32 channel cardiac coils in 196 patients (mean age, 68 ± 11; male 60%) with suspected CAD but without known CAD. LVEF was measured from cine MRI, and LGE and significant coronary stenosis (diameter stenosis ≥ 50%) were determined from LGE-MRI and CMRA, respectively. Major adverse cardiac events (MACEs) were defined as cardiac death, acute myocardial infarction, unstable angina, heart failure, and ventricular arrhythmia.

Results During a median follow-up period of 25 months (interquartile range, 16-32 months), MACEs were observed in 13 patients (1 cardiac death, 10 unstable angina, 2 heart failure). Annualized event rate was higher in patients with LVEF<50% (9.0% vs. 2.5%, Log-rank p<0.001), in those with LGE (7.1% vs. 2.2%, p=0.001), and in those with significant stenosis (7.1% vs. 0.3%, p<0.001). On Cox proportional hazards analysis, presence of significant stenosis on CMRA was independent predictor of MACE after correction of clinical information (age, gender, hypertension, diabetes, hyperlipidemia, smoking, family history of premature CAD, obesity), LVEF<50% and LGE (hazard ratio, 11.29;95% confidential interval, 1.27-100.75, p=0.030).

Conclusions The presence of significant stenosis on CMRA independently predicts subsequent cardiac events. Using whole-heart CMRA in conjunction with cine- and LGE-MRI provides improved prediction of MACE in comparison with clinical predictors, LVEF, and LGE in patients with suspected CAD.