Association between severity of ischemia evaluated by stress CMR and Syntax score in patients with stable coronary artery disease

Abstract

Abstract Dipiridamol stress cardiac magnetic resonance (CMR) had proved to be useful to evaluate the benefit of revascularization in stable coronary artery disease [1]. Nevertheless the association between stress CMR imaging parameters and coronary Syntax score has not yet be fully evaluated. Objective To analyze the association of the extent and transmurality of ischemia and necrosis analyzed by vasodilators stress CMR with the severity and prognosis of coronary artery disease assessed by the Syntax score. Methods A retrospective cohort study including consecutive patients with stable coronary artery disease with inducible ischaemia in vasodilators stress CMR who underwent post-study catheterization was performed. The CMR protocol includes a functional study with b-SSFP sequences, first-pass perfusion with b-SSFP sequences obtained after administration of 0.84mg/kg of dipyridamole and during administration of gadolinium chelates and also IR-FGE viability sequences. A post-stress perfusion (PSP) and viability (V) score was developed scoring each segment from 0 to 2 according to transmurality. The number of segments with induced wall motion abnormalities (NSIWA) were also analyzed. The Syntax I and II scores were calculated using data from coronary angiography and computerized medical records. Results 208 patients were included, mean age 65±13 years, 44% women, 109 of them revascularized after stress CMR, 13 of them by surgery. Univariate analysis showed a significant correlation of the PSP, NSIWA and V scores with the Syntax I and Syntax 2. Using a multivariate regression models, NSIWA and V scores were independent predictors for Syntax I while NSIWA and PSP were independent predictors for Syntax 2. Conclusions – CMR stress test in patients with stable coronary artery disease allows an integrative assessment of V, PSP and PSWA and all of this parameters were associated with the severity of coronary artery disease and the prognosis after revascularization estimated by the Syntax I and 2. – NSIWA and V independently predict the severity of coronary artery disease estimated using Syntax I. – NSIWA and PSP independently predict prognosis after revascularization estimated for surgery using Syntax 2. Funding Acknowledgement Type of funding sources: None.