Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population

Bertaso, A.; Richardson, J. David; Wong, D.; Cunnington, Michael S.; Nelson, Adam; Tayeb, H.; Williams, K.; Chew, Derek P.; Worthley, M.; Teo, K.; Worthley, Stephen G.

doi:10.1016/j.ijcard.2012.05.051

Cited by 18 publications

(8 citation statements)

References 39 publications

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“…This confirms the results of earlier controlled studies in smaller (often single-center) populations [25-27] in a multi-national and multi-ethnical clinical routine setting, underscoring the prognostic value of clinical routine CMR for this indication.…”

Section: Discussionsupporting

confidence: 86%

European cardiovascular magnetic resonance (EuroCMR) registry – multi national results from 57 centers in 15 countries

Bruder

Wagner

Lombardi

et al. 2013

Journal of Cardiovascular Magnetic Resonance

223

145

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BackgroundThe EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR.MethodsMulti-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled.ResultsThe most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year).ConclusionThe most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.Condensed abstractThe EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting in a large number of cases (n > 27000). Based on our data CMR is frequently performed in European daily clinical routine. The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

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Section: Discussionsupporting

confidence: 86%

European cardiovascular magnetic resonance (EuroCMR) registry – multi national results from 57 centers in 15 countries

Bruder

Wagner

Lombardi

et al. 2013

Journal of Cardiovascular Magnetic Resonance

223

145

View full text Add to dashboard Cite

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“…Forty-five of these articles warranted full-text review. Twenty-six articles (5–9,17–37) were excluded for various reasons, including cohort overlap with other articles or lack of our prespecified outcomes, leaving 19 articles for detailed study (38–56). The details of our flow diagram can be found in Figure 1, and study characteristics are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The 19 studies with a weighted mean follow-up of 32 months (median 25 months; range 9 to 72 months) included a total of 11,636 patients with known or suspected CAD undergoing stress CMR (14 vasodilator stress [38–44,46–52]; 4 dobutamine stress [53–56]; and 1 using both vasodilator and dobutamine stress [45]) (median 362 patients; average 612 patients [range: 27 to 1,722]). Patients had a weighted mean age of 63 ± 12 years, and 63% of patients were male.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Value of Stress Cardiac Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

Lipinski

McVey

Berger

et al. 2013

Journal of the American College of Cardiology

225

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Objectives This study sought to perform a systematic review and meta-analysis to understand the role of stress cardiac magnetic resonance imaging (CMR) in assessing cardiovascular prognosis in patients with known or suspected coronary artery disease (CAD). Background Although stress CMR is excellent for the diagnosis of obstructive CAD, the prognostic value of stress CMR has been less well described. Methods PubMed, Cochrane CENTRAL, and metaRegister of Controlled Trials were searched for stress CMR studies with >6 months of prognostic data. Primary endpoints were cardiovascular death, myocardial infarction (MI), and a composite outcome of cardiovascular death or MI during follow-up. Summary effect estimates were generated with random-effects modeling, and annualized event rates were assessed. Results Nineteen studies (14 vasodilator, 4 dobutamine, and 1 that used both) involved a total of 11,636 patients with a mean follow-up of 32 months. Patients had a mean age of 63 ± 12 years, 63% were male, and 26% had previous MI; mean left ventricular ejection fraction was 61 ± 12%; and late gadolinium enhancement was present in 29% and ischemia in 32%. Patients with ischemia had a higher incidence of MI (odds ratio [OR]: 7.7; p < 0.0001), cardiovascular death (OR: 7.0; p < 0.0001), and the combined endpoint (OR: 6.5; p < 0.0001) compared with those with a negative study. The combined outcome annualized events rates were 4.9% for a positive versus 0.8% for a negative stress CMR (p < 0.0001), 2.8% versus 0.3% for cardiovascular death (p < 0.0001), and 2.6% versus 0.4% for MI (p < 0.0005). The presence of late gadolinium enhancement was also significantly associated with a worse prognosis. Conclusions A negative stress CMR study is associated with very low risk of cardiovascular death and MI. Stress CMR has excellent prognostic characteristics and may help guide risk stratification of patients with known or suspected CAD.

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“…Several studies have previously demonstrated the usefulness of both vasodilator perfusion and dobutamine stress CMR for the estimation of clinical outcomes in patients with CAD (Ingkanisorn et al, 2006; Bodi et al, 2007; Jahnke et al, 2007, 2012; Pilz et al, 2008; Doesch et al, 2009; Lerakis et al, 2009; Steel et al, 2009; Vogel-Claussen et al, 2009; Charoenpanichkit et al, 2010; Korosoglou et al, 2010b; Bingham and Hachamovitch, 2011; Coelho-Filho et al, 2011; Gebker et al, 2011, 2012; Kelle et al, 2011; Krittayaphong et al, 2011; Lo et al, 2011; Lubbers et al, 2012; Bertaso et al, 2013; Buckert et al, 2013, reviewed in Lipinski et al, 2013). A recent meta-analysis systematically analyzed these data, including 14 vasodilator, 4 dobutamine studies and 1 study using both adenosine and dobutamine in a total of over 11,500 patients and with a mean follow-up duration of over 2.5 years (Lipinski et al, 2013).…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

et al. 2014

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Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.

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Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population

Cited by 18 publications

References 39 publications

European cardiovascular magnetic resonance (EuroCMR) registry – multi national results from 57 centers in 15 countries

European cardiovascular magnetic resonance (EuroCMR) registry – multi national results from 57 centers in 15 countries

Prognostic Value of Stress Cardiac Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

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