Stress Perfusion Cardiac Magnetic Resonance in Long-Standing Non-Infarcted Chronic Coronary Syndrome with Preserved Systolic Function

Abstract

(1) Background: The impact of imaging-derived ischemia is still under debate and the role of stress perfusion cardiac magnetic resonance (spCMR) in non-high-risk patient still needs to be clarified. The aim of this study was to evaluate the impact of spCMR in a case series of stable long-standing chronic coronary syndrome (CCS) patients with ischemia and no other risk factor. (2) Methods: This is a historical prospective study including 35 patients with history of long-standing CCS who underwent coronary CT angiography (CCTA) and additional adenosine spCMR. Clinical and imaging findings were included in the analysis. Primary outcomes were HF (heart failure) and all major cardiac events (MACE) including death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, or resuscitated cardiac arrest. (3) Results: Mean follow-up was 3.7 years (IQR: from 1 to 6). Mean ejection fraction was 61 ± 8%. Twelve patients (31%) referred primary outcomes. Probability of experiencing primary outcomes based on symptoms was 62% and increased to 67% and 91% when multivessel disease and ischemia, respectively, were considered. Higher ischemic burden was predictive of disease progression (OR: 1.59, 95%CI: 1.18–2.14; p-value = 0.002). spCMR model resulted non inferior to the model comprising all variables (4) Conclusions: In vivo spCMR-modeling including perfusion and strain anomalies could represent a powerful tool in long-standing CCS, even when conventional imaging predictors are missing.

Focal and diffuse myocardial fibrosis both contribute to regional hypoperfusion assessed by post-processing quantitative-perfusion MRI techniques

“…Similarly, it was reported in hypertrophic cardiomyopathy patients that comparison of global MBF did not differ between patients with and without visual perfusion deficits, but investigation of individual segments revealed significant insights into regional decrease in perfusion (14). Thus, segmental analysis is beneficial to verify hypoperfusion, and to co-localize associated myocardial features (15)(16)(17).…”

Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies

“…CMR as we shown before this technique can aid in the differentiation of ischemic from non-ischemic cardiomyopathy subtypes. Currently, CMR-derived cardiac imaging is effective for both definition of IHD and for ischemia detection, with important diagnostic and prognostic implications[ 15 ].…”

The Multi-Faceted Utility of Cardiovascular Magnetic Resonance Imaging: Editorial on Special Issue “Advances in Cardiovascular Magnetic Resonance”

“…Palumbo et al evaluated the role of stress perfusion cardiac magnetic resonance (spCMR) in predicting the risk of major cardiac events in patients with long-standing chronic coronary syndrome (CCS) and ischemia [3]. They included 35 patients who underwent coronary CT angiography (CCTA) and additional adenosine spCMR and the primary outcomes measured were heart failure and all major cardiac events.…”