Abstract 13477: Feasibility and Prognostic Value of Vasodilator Stress Perfusion Cardiovascular Magnetic Resonance in Patients With Atrial Fibrillation

Abstract

Introduction: Because most studies have excluded arrhythmic patients, the prognostic value of stress perfusion CMR in patients with atrial fibrillation (AF) is unknown. Hypothesis: To assess the feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF. Methods: Between 2008 and 2018, consecutive patients with suspected or stable chronic coronary artery disease (CAD) and AF referred for vasodilator stress perfusion CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or non-fatal myocardial infarction. The diagnosis of AF was defined by 12-lead electrocardiogram before and after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. Results: Of 639 patients (72±9 years, 77% men), 602 (94%) completed the CMR protocol, and 538 (89%) completed the follow-up (median 5.1 years); 80 had a MACE. Stress CMR was well tolerated. Using Kaplan-Meier analysis, the presence of ischemia or LGE was associated with the occurrence of MACE (HR 7.56; 95% CI: 4.86-11.80 and HR 2.41; 95% CI: 1.55-3.74 respectively; for both p <0.001). In a multivariable Cox regression including clinical and CMR indexes, the presence of ischemia or LGE was an independent predictor of MACE (HR 5.98; 95% CI: 3.68-9.73 and HR 2.61; 95% CI: 1.89-3.60 respectively; for both p <0.001). Conclusions: In patients with AF, stress perfusion CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE.