Prognostic Value of Stress Cardiac Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-Analysis

doi:10.1016/j.jacc.2013.03.080

Journal of the American College of Cardiology

Volume 62, Issue 9, 27 August 2013, Pages 826-838

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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.

Key Words

late gadolinium enhancement

myocardial perfusion

prognosis

stress cardiac MRI

Abbreviations and Acronyms

AER

annualized event rate

CAD

coronary artery disease

CMR

cardiac magnetic resonance imaging

LGE

late gadolinium enhancement

MACE

major adverse cardiovascular event(s)

myocardial infarction

odds ratio

Cited by (0)

: Dr. Kramer has received research equipment support from Siemens Healthcare and has served as a consultant for Synarc. Dr. Salerno has received research support from Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Lipinski and McVey contributed equally to this work.