Abstract 14177: Prognostic Value of Normal Regadenoson Stress Cardiovascular Magnetic Resonance Myocardial Perfusion Imaging
Background: Although regadenoson has been extensively studied in patients undergoing nuclear myocardial perfusion imaging (MPI), its use with cardiovascular magnetic resonance (CMR) for stress-MPI is not well described. The aim of this study was to determine the prognostic value of a normal regadenoson CMR-MPI in patients with known or suspected coronary artery disease (CAD).
Methods: 130 patients with known or suspected CAD were prospectively enrolled to receive CMR-MPI with regadenoson. Three short-axis slices of the left ventricle (LV) were obtained during first pass of contrast using a hybrid GRE-EPI pulse sequence. Imaging was performed 1 minute after injection of regadenoson and repeated 15 minutes after reversal of hyperemia with aminophylline. Standard late gadolinium enhancement (LGE) and cine images were also acquired. Perfusion defects were documented if they persisted for ≥2 frames after peak enhancement of the LV cavity. CMR was considered abnormal if there was a resting wall motion abnormality, decreased LVEF (<40%), presence of LGE, or the presence of a stress-induced perfusion defect. All patients were followed for a minimum of 1 year for major adverse cardiovascular event (MACE) defined as coronary revascularization, non-fatal myocardial infarction, and cardiovascular death.
Results: 117 patients were included in the final analysis. Perfusion defects were noted in 32/117 (27%) patients; 43/117 (37%) had abnormal CMR. During the mean follow-up period of 19±6 months, 12/117 (10.3%) patients experienced MACE. The separation in the survival curves for those with and without perfusion defects was highly significant (log-rank p=0.0001). When the absence of perfusion defects was added to the absence of other resting CMR abnormalities, the negative predictive value improved from 94% to 99% (figure).
Conclusion: Regadenoson CMR-MPI provides high confidence for excellent prognosis in patients with a normal study.
- © 2013 by American Heart Association, Inc.