Incremental prognostic value of coronary flow reserve determined by phase-contrast cine cardiovascular magnetic resonance of the coronary sinus in patients with diabetes mellitus

Abstract

Background Although non-invasive assessment of coronary flow reserve (CFR) by cardiovascular magnetic resonance (CMR) provides prognostic information for patients with diabetes mellitus (DM), the incremental prognostic value of CMR-derived CFR remains unclear. Purpose To evaluate the incremental prognostic value of CMR-derived CFR for patients with DM who underwent stress CMR imaging. Materials and methods A total of 309 patients with type 2 DM [69 ± 9 years; 244 (78%) male] assessed between 2009 and 2019 were retrospectively reviewed. Coronary sinus blood flow (CSBF) was measured using phase contrast (PC) cine CMR. CFR was calculated as the CSBF during adenosine triphosphate infusion divided by that at rest. Major adverse cardiac events (MACE) were defined as death, acute coronary syndrome, hospitalization due to heart failure exacerbation, or sustained ventricular tachycardia. The incremental prognostic value of CFR over clinical and CMR variables was assessed by calculating the C-index and net reclassification improvement (NRI). Results During a median follow-up of 3.8 years, 42 patients (14%) experienced MACE. The annualized event rate was significantly higher among patients with CFR < 2.0, regardless of the presence of late gadolinium enhancement (LGE) (1.4% vs. 9.8%, p = 0.011 in the LGE (−) group; 1.8% vs. 16.9%, p < 0.001 in the LGE (+) group). In addition, this trend was maintained in the subgroups stratified by presence or absence of ischemia (0.3% vs. 6.7%, p = 0.007 in the ischemia (−) group; 3.9% vs. 17.1%, p = 0.001 in the ischemia (+) group). Adding CFR to the risk model (age + gender + left ventricular ejection fraction + %LGE + %ischemia) resulted in a significant increase of the C-index from 0.838 to 0.870 (p = 0.038) and an NRI of 0.201 (0.004–0.368, p = 0.012). Conclusion PC cine CMR-derived CFR of the coronary sinus may be useful as a prognostic marker for DM patients, incremental to common clinical and CMR parameters. Due to the high prevalence of coronary microvascular dysfunction, the addition of CFR to conventional vasodilator stress CMR imaging may improve risk stratification for patients with DM.

A cardiovascular magnetic resonance imaging-based pilot study to assess coronary microvascular disease in COVID-19 patients

“…It needs to be considered that CSF-based MPR is not only reduced by the presence of obstructive epicardial stenosis—but is also affected by relevant microvascular changes. This notion is further supported by the fact that an incremental prognostic value of CMR-derived MPR was detected for patients with diabetes undergoing stress CMR imaging 21 . The annualized MACE rate was substantially higher in those patients with MPR < 2.0—regardless of the presence or absence of LGE.…”

Cardiovascular magnetic resonance assessment of coronary flow reserve improves risk stratification in heart failure with preserved ejection fraction

“…Validation studies of this imaging technique have been performed using phantom models [ 33 ], animal experimental models using flow probes [ 18 ] and PET [ 16 ]. Recent studies have shown the prognostic importance of CMR-derived CFR for atherosclerotic diseases, such as CAD [ 20 , 21 ] or diabetes mellitus [ 22 , 23 ]. Additionally, this method is potentially useful for evaluating reduced CFR in patients with non-atherosclerotic diseases, including hypertrophic cardiomyopathy [ 15 , 34 ], dilated cardiomyopathy [ 19 ] and HFpEF [ 9 ].…”

“…Phase contrast (PC) cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive means to quantify CFR [ 15 – 19 ]. Recent studies have shown the prognostic implication of CMR-derived CFR for coronary artery disease [ 20 , 21 ] or diabetes mellitus [ 22 , 23 ]. Regarding HFpEF, the CMR-derived CFR has been found to be significantly lower compared with that in hypertensive left ventricular (LV) hypertrophy and controls, and was correlated with serum brain natriuretic peptide (BNP) level [ 24 ].…”

Influence of heliogeophysical factors on patients with myocardial infarction

“…The most adverse impact was associated with cold and wet weather with low atmospheric pressure, which is common in Helsinki in early winter and late autumn. 39 Despite the numerous literature data on the close dependence of the development and outcomes of MI on heliogeophysical factors, there are studies in which the relationship between the incidence rate and the course of the 11-year solar cycle was not noted, and no connection was found when comparing the monthly incidence with the average monthly values of Wolf numbers, due to which, it seems that the course of CVD is a test incomparably more complex than chemical, leukocyte and epidemiological tests, and its correlation with SA is much more complicated than with simple tests. Similar results were obtained by American researchers for 4 years of studying mortality from coronary insufficiency and CSs (275 million indicators).…”