PMID- 30409558 OWN - NLM STAT- MEDLINE DCOM- 20200324 LR - 20201009 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 12 IP - 8 Pt 2 DP - 2019 Aug TI - Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events. PG - 1686-1695 LID - S1936-878X(18)30745-9 [pii] LID - 10.1016/j.jcmg.2018.08.018 [doi] AB - OBJECTIVES: The aim of this study was to evaluate the incremental prognostic value of global coronary flow reserve (CFR) in patients with known or suspected coronary artery disease who were undergoing stress cardiac magnetic resonance (CMR) imaging. BACKGROUND: Coronary microvascular dysfunction results in impaired global CFR and is implicated in the development of both atherosclerosis and heart failure. Although noninvasive assessment of CFR with positron emission tomography provides independent prognostic information, the incremental prognostic value of CMR-derived CFR remains unclear. METHODS: Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 507). Coronary sinus flow was measured using phase-contrast imaging at baseline (pre) and immediately after stress (peak) perfusion. CFR was calculated as the ratio of peak to pre-flow. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between CFR and MACE. The incremental prognostic value of CFR was assessed in nested models. RESULTS: Over a median follow-up of 2.1 years, 80 patients experienced MACE. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with CFR lower than the median (2.2) (log-rank p < 0.001); this remained significant after adjustment for the presence of ischemia and late gadolinium enhancement (LGE) (log-rank p < 0.001). CFR was significantly associated with the risk of MACE after adjustment for clinical and imaging risk factors, including ischemia extent, ejection fraction, and LGE size (hazard ratio: 1.238; p = 0.018). Addition of CFR in this model resulted in significant improvement in the C-index (from 0.70 to 0.75; p = 0.0087) and a continuous net reclassification improvement of 0.198 (95% confidence interval: 0.120 to 0.288). CONCLUSIONS: CMR-derived CFR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and CMR risk factors. These findings suggest a role for CMR-derived CFR in identifying patients at risk of adverse events following stress CMR, even in the absence of ischemia and LGE. CI - Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Indorkar, Raksha AU - Indorkar R AD - Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. FAU - Kwong, Raymond Y AU - Kwong RY AD - Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Romano, Simone AU - Romano S AD - Department of Medicine, University of Verona, Verona, Italy. FAU - White, Brent E AU - White BE AD - Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. FAU - Chia, Richard C AU - Chia RC AD - Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. FAU - Trybula, Michael AU - Trybula M AD - Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. FAU - Evans, Kaleigh AU - Evans K AD - Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. FAU - Shenoy, Chetan AU - Shenoy C AD - Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. FAU - Farzaneh-Far, Afshin AU - Farzaneh-Far A AD - Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina. Electronic address: afshin@uic.edu. LA - eng GR - K23 HL132011/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 - 20181105 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Vasodilator Agents) SB - IM CIN - JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1696-1698. PMID: 30409556 MH - Adult MH - Aged MH - Blood Flow Velocity MH - Coronary Artery Disease/*diagnostic imaging/mortality/physiopathology/therapy MH - Coronary Sinus/*diagnostic imaging/physiopathology MH - Disease Progression MH - Female MH - *Fractional Flow Reserve, Myocardial MH - Humans MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocardial Perfusion Imaging/*methods MH - Predictive Value of Tests MH - Prognosis MH - Prospective Studies MH - Risk Assessment MH - Risk Factors MH - Vasodilator Agents/*administration & dosage OTO - NOTNLM OT - cardiac magnetic resonance imaging OT - coronary artery disease OT - coronary flow reserve OT - coronary microvascular function OT - microcirculation OT - prognosis OT - stress testing EDAT- 2018/11/10 06:00 MHDA- 2020/03/25 06:00 CRDT- 2018/11/10 06:00 PHST- 2018/07/03 00:00 [received] PHST- 2018/07/27 00:00 [revised] PHST- 2018/08/01 00:00 [accepted] PHST- 2018/11/10 06:00 [pubmed] PHST- 2020/03/25 06:00 [medline] PHST- 2018/11/10 06:00 [entrez] AID - S1936-878X(18)30745-9 [pii] AID - 10.1016/j.jcmg.2018.08.018 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1686-1695. doi: 10.1016/j.jcmg.2018.08.018. Epub 2018 Nov 5.