Is myocardial stress perfusion MR-imaging suitable to predict the long term clinical outcome after revascularization?

• Published in: European journal of radiology 2013-10, Vol.82 (10), p.1776-1782
• Main Authors: Klumpp, B, Seeger, A, Bretschneider, C, Mangold, S, Krumm, P, Miller, S, Claussen, C.D, Gawaz, M.P, May, A.E, Kramer, U
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiac MRI; Comorbidity; Coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Exercise Test - statistics & numerical data; Female; Germany - epidemiology; Humans; Magnetic Resonance Angiography - statistics & numerical data; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Myocardial perfusion; Myocardial Revascularization; Prevalence; Prognosis; Prognosis after revascularization; Radiology; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Survival Rate; Treatment Outcome
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2013.06.003

Abstract Introduction Aim of our study was to evaluate, whether myocardial ischemia or myocardial infarction (MI) depicted by myocardial stress perfusion MR imaging (SP CMR) can predict the clinical outcome in patients with coronary artery disease (CAD). Materials and method 220 patients were included. Myocardial perfusion was assessed at stress and at rest, using a 2D saturation recovery gradient echo sequence (SR GRE) and myocardial viability by late gadolinium enhancement magnetic resonance images (LGE CMR). MR-images were assessed in regard of presence and extent of MI and ischemia. Patients were monitored for major adverse cardiac events (MACE) (monitoring period: 5–7 years). MACE were correlated with the initial results of SP CMR. Results Ischemia was found in 143 patients, MI in 107 patients. Number of MACE was in patients with normal SP CMR 0 (51 patients), with ischemia 21 (62 patients), with MI 14 (26 patients), with ischemia and MI 52 (81 patients). In all patients with severe MACE (MI, death) and in 63 of those with recurring symptoms LGE CMR revealed MI at baseline. Conclusion Negative SP CMR indicates low risk for MACE. In patients with stress induced ischemia, MACE might occur even after myocardial revascularization. The presence of MI proved by LGE CMR is associated with a significantly increased risk for MACE.