PMID- 19770399 OWN - NLM STAT- MEDLINE DCOM- 20091023 LR - 20211020 IS - 1524-4539 (Electronic) IS - 0009-7322 (Print) IS - 0009-7322 (Linking) VI - 120 IP - 14 DP - 2009 Oct 6 TI - Complementary prognostic values of stress myocardial perfusion and late gadolinium enhancement imaging by cardiac magnetic resonance in patients with known or suspected coronary artery disease. PG - 1390-400 LID - 10.1161/CIRCULATIONAHA.108.812503 [doi] AB - BACKGROUND: Recent studies have demonstrated the significant prognostic value of stress cardiac magnetic resonance (CMR) myocardial perfusion imaging. Apart from characterizing reversible perfusion defect (RevPD) from flow-limiting coronary stenosis, CMR late gadolinium enhancement (LGE) imaging is currently the most sensitive method for detecting subendocardial infarction (MI). We therefore tested the hypothesis that characterization of these 2 processes from coronary artery disease by CMR can provide complementary prognostic values. METHODS AND RESULTS: We performed CMR myocardial perfusion imaging followed by LGE imaging on 254 patients referred with symptoms of myocardial ischemia. At a median follow-up of 17 months, 49 cardiac events occurred, including 12 cardiac deaths, 16 acute MIs, and 21 cardiac hospitalizations. RevPD and LGE both maintained a >3-fold association with cardiac death or acute MI (death/MI) when adjusted for each other and for the effects of patient age and gender (adjusted hazard ratio, 3.31; P=0.02; and hazard ratio, 3.43; P=0.01, respectively). In patients without a history of MI who had negative RevPD, LGE presence was associated with a >11-fold hazards increase in death/MI. Patients with neither RevPD nor LGE had a 98.1% negative annual event rate for death/MI. For association with major adverse cardiac events, RevPD was the strongest multivariable variable in the best overall model (hazard ratio, 10.92; P<0.0001). CONCLUSIONS: CMR imaging provides robust risk stratification for patients who present with symptoms of ischemia. Characterization of RevPD and LGE by CMR provides strong and complementary prognostic implication for cardiac death or acute MI. FAU - Steel, Kevin AU - Steel K AD - Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. FAU - Broderick, Ryan AU - Broderick R FAU - Gandla, Vijay AU - Gandla V FAU - Larose, Eric AU - Larose E FAU - Resnic, Frederick AU - Resnic F FAU - Jerosch-Herold, Michael AU - Jerosch-Herold M FAU - Brown, Kenneth A AU - Brown KA FAU - Kwong, Raymond Y AU - Kwong RY LA - eng GR - R01 HL091157/HL/NHLBI NIH HHS/United States GR - R01 HL091157-02/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20090921 PL - United States TA - Circulation JT - Circulation JID - 0147763 SB - IM CIN - Circulation. 2009 Oct 6;120(14):1342-4. PMID: 19770390 MH - Adult MH - Aged MH - Angina Pectoris/complications/diagnostic imaging/pathology MH - Angina, Unstable/complications/diagnostic imaging/pathology MH - Coronary Disease/complications/diagnosis/*pathology MH - Female MH - Heart Diseases/complications/mortality/pathology MH - Humans MH - Magnetic Resonance Angiography MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Myocardial Infarction/complications/diagnosis/diagnostic imaging/epidemiology/mortality/*pathology MH - Myocardial Ischemia/complications/diagnosis/diagnostic imaging/pathology MH - Myocardial Perfusion Imaging/*methods MH - Prognosis MH - Proportional Hazards Models MH - Radiography PMC - PMC2766555 MID - NIHMS149329 EDAT- 2009/09/23 06:00 MHDA- 2009/10/24 06:00 PMCR- 2010/10/06 CRDT- 2009/09/23 06:00 PHST- 2009/09/23 06:00 [entrez] PHST- 2009/09/23 06:00 [pubmed] PHST- 2009/10/24 06:00 [medline] PHST- 2010/10/06 00:00 [pmc-release] AID - CIRCULATIONAHA.108.812503 [pii] AID - 10.1161/CIRCULATIONAHA.108.812503 [doi] PST - ppublish SO - Circulation. 2009 Oct 6;120(14):1390-400. doi: 10.1161/CIRCULATIONAHA.108.812503. Epub 2009 Sep 21.