Prognostic value of dobutamine stress cardiovascular magnetic resonance in patients with previous coronary revascularization

Kelle, Sebastian; Gebker, Rolf; Chiribiri, Amedeo; Vierecke, Juliane; Egnell, Christina; Wellnhofer, Ernst; Klein, Christoph; Fleck, Eckart

doi:10.1186/1532-429x-13-s1-p165

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“…A total of 22 studies pooling 17 084 individuals reported MACE data. The presence of inducible ischemia was associated with a 5-fold higher likelihood of incident MACEs (OR, 5.33; 95% CI, 4.04-7.04; P < .001) (Figure 5).…”

Section: Resultsmentioning

confidence: 99%

“…The Deeks test was not performed in FFR studies because the number of studies was insufficient. With regard to prognostic studies, we ruled out publication bias by visual inspection of funnel plots and the Egger test of intercept, which was nonsignificant for each outcome (eFigure 4 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…Of 3144 records (1152 diagnostic studies and 1992 prognostic studies) identified and retrieved for title and abstract evaluation, 2909 (1038 diagnostic studies and 1871 prognostic studies) were excluded, resulting in 235 potentially relevant articles (114 diagnostic studies and 121 prognostic studies) included in the full-text assessment of eligibility. After exclusions, 64 studies, including 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals, published between October 29, 2002, and October 19, 2021, were included in the meta-analysis (eFigure 1 in Supplement 1). The study-level prevalence of CAD ranged between 11% and 83% in diagnostic studies.…”

Section: Resultsmentioning

confidence: 99%

“…The overall quality of included studies was high (eFigure 2 and eTable 3 in Supplement 1). The main characteristics of studies included in the diagnostic and prognostic meta-analyses are summarized in eTables 1 and 2 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“…According to the QUADAS-2 tool, risk of bias was low in 29 of 33 diagnostic studies (eFigure 2 in Supplement 1). Of 31 prognostic studies, 15 studies scored 9 stars and 16 studies scored 8 stars according to the Newcastle-Ottawa Scale (eTable 3 in Supplement 1). In ICA studies, the Deeks test ruled out small study bias and publication bias ( P = .34) (eFigure 3 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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ImportanceThe clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown.ObjectiveTo provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain.Data SourcesPubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021.Study SelectionSelected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included.Data Extraction and SynthesisThis systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Main Outcomes and MeasuresDiagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death.ResultsA total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%.Conclusion and RelevanceIn this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%