PMID- 28412420 OWN - NLM STAT- MEDLINE DCOM- 20171218 LR - 20181015 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 10 IP - 5 DP - 2017 May TI - Stress Perfusion CMR in Patients With Known and Suspected CAD: Prognostic Value and Optimal Ischemic Threshold for Revascularization. PG - 526-537 LID - S1936-878X(17)30189-4 [pii] LID - 10.1016/j.jcmg.2017.02.006 [doi] AB - OBJECTIVES: This study sought to determine the ischemia threshold and additional prognostic factors that identify patients for safe deferral from revascularizations in a large cohort of all-comer patients with known or suspected coronary artery disease (CAD). BACKGROUND: Stress-perfusion cardiac magnetic resonance (CMR) is increasingly used in daily practice for ischemia detection. However, there is insufficient evidence about the ischemia burden that identifies patients who benefit from revascularization versus those with a good prognosis who receive drugs only. METHODS: All patients with known or suspected CAD referred to stress-perfusion CMR for myocardial ischemia assessment were prospectively enrolled. The CMR examination included standard functional adenosine stress first-pass perfusion (gadobutrol 0.1 mmol/kg Gadovist, Bayer AG, Zurich, Switzerland) and late gadolinium enhancement (LGE) acquisitions. Presence of ischemia and ischemia burden (number of ischemic segments on a 16-segment model), and of scar and scar burden (number and transmurality of scar segments in a 17-segment model) were assessed. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction (MI), and late coronary revascularization (>90 days post-CMR); the secondary endpoint was a composite of cardiac death and nonfatal MI. RESULTS: During a follow-up of 2.5 +/- 1.0 years, 86 and 32 of 1,024 patients (1,103 screened patients) experienced the primary and secondary endpoints, respectively. On Kaplan-Meier curves for the primary and secondary endpoints, patients without ischemia had excellent outcomes that did not differ from patients with <1.5 ischemic segments. In multivariate Cox regression analyses of the entire population and of the subgroups, ischemia burden (threshold: >/=1.5 ischemic segments) was consistently the strongest predictor of the primary and secondary endpoints with hazard ratios (HRs) of 7.42 to 8.72 (p < 0.001), whereas age (>/=67 years), left ventricular ejection fraction (/=0.03) contributed significantly, but to a lesser extent, in all models with HRs of 2.01 to 3.48, 1.75 to 1.96, and 1.66 to 1.76, respectively. CONCLUSIONS: In a large all-comer patient cohort with known and suspected CAD, an ischemia burden of >/=1.5 ischemic segments on stress-perfusion CMR was the strongest predictor of the primary and secondary endpoints. Patients with zero or 1 ischemic segment can be safely deferred from revascularizations. CI - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Vincenti, Gabriella AU - Vincenti G AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Masci, Pier Giorgio AU - Masci PG AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Monney, Pierre AU - Monney P AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Rutz, Tobias AU - Rutz T AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Hugelshofer, Sarah AU - Hugelshofer S AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Gaxherri, Mirdita AU - Gaxherri M AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Muller, Olivier AU - Muller O AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Iglesias, Juan F AU - Iglesias JF AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Eeckhout, Eric AU - Eeckhout E AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland. FAU - Lorenzoni, Valentina AU - Lorenzoni V AD - Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy. FAU - Pellaton, Cyril AU - Pellaton C AD - Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Division of Cardiology, Department of Internal Medicine, Neuchatel, Switzerland. FAU - Sierro, Christophe AU - Sierro C AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Division of Cardiology, Centre Hospitalier du Valais Romand (CHVR), Sion, Switzerland. FAU - Schwitter, Juerg AU - Schwitter J AD - Division of Cardiology University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. Electronic address: jurg.schwitter@chuv.ch. LA - eng PT - Journal Article DEP - 20170412 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 0 (Vasodilator Agents) RN - 1BJ477IO2L (gadobutrol) RN - K72T3FS567 (Adenosine) SB - IM CIN - JACC Cardiovasc Imaging. 2017 May;10(5):538-540. PMID: 28473099 MH - Adenosine/*administration & dosage MH - Aged MH - Contrast Media/administration & dosage MH - Coronary Artery Disease/*diagnostic imaging/mortality/physiopathology/*therapy MH - *Coronary Circulation MH - Coronary Vessels/*diagnostic imaging/physiopathology MH - Female MH - Humans MH - Kaplan-Meier Estimate MH - *Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Myocardial Infarction/mortality/physiopathology MH - Myocardial Perfusion Imaging/*methods MH - *Myocardial Revascularization MH - Myocardium/pathology MH - Organometallic Compounds/administration & dosage MH - Predictive Value of Tests MH - Prognosis MH - Proportional Hazards Models MH - Prospective Studies MH - Registries MH - Risk Factors MH - Severity of Illness Index MH - Stroke Volume MH - Time Factors MH - Vasodilator Agents/*administration & dosage MH - Ventricular Function, Left OTO - NOTNLM OT - cardiac magnetic resonance OT - coronary artery disease OT - ischemia burden OT - outcome OT - prognosis OT - scar burden EDAT- 2017/04/17 06:00 MHDA- 2017/12/19 06:00 CRDT- 2017/04/17 06:00 PHST- 2016/09/26 00:00 [received] PHST- 2017/02/21 00:00 [revised] PHST- 2017/02/23 00:00 [accepted] PHST- 2017/04/17 06:00 [pubmed] PHST- 2017/12/19 06:00 [medline] PHST- 2017/04/17 06:00 [entrez] AID - S1936-878X(17)30189-4 [pii] AID - 10.1016/j.jcmg.2017.02.006 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2017 May;10(5):526-537. doi: 10.1016/j.jcmg.2017.02.006. Epub 2017 Apr 12.