Abstract
BackgroundPhase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to measure coronary sinus blood flow (CSBF) and coronary flow reserve (CFR). We aimed to compare the prognostic value of resting CSBF and CFR for predicting major adverse cardiac events (MACE) in patients with known or suspected coronary artery disease (CAD) who underwent vasodilator stress CMR.MethodsWe studied 693 patients with known CAD and 519 patients with suspected CAD admitted to our hospital between 2009 and 2019. The CFR was calculated as the CSBF during adenosine triphosphate infusion divided by CSBF at rest. MACE was defined as composite of cardiovascular death, acute coronary syndrome, heart failure hospitalization, and sustained ventricular tachyarrhythmia.ResultsDuring a median follow-up of 4.6 years, 92 patients (8%) experienced MACE. The resting CSBF was significantly higher in patients with MACE than in patients without MACE (114.7 ± 44.9 mL/min vs. 84.7 ± 30.9 mL/min, p < 0.001 for known CAD; 122.2 ± 33.3 mL/min vs. 86.6 ± 36.7 mL/min, p < 0.001 for suspected CAD). The resting CSBF remained a significant predictor for MACE after adjusting clinical and CMR variables (hazard ratio [HR] of resting CSBF higher than the median: 3.18, p = 0.0083 for known CAD; HR: 23.3, p < 0.001 for suspected CAD). The area under the curve for predicting MACE was 0.73 for resting CSBF, 0.72 for CFR (p = 0.78) in patients with known CAD, and 0.82 for resting CSBF, 0.83 (p = 0.58) for CFR in patients with suspected CAD.ConclusionsThe resting CSBF may be a useful non-invasive method for the risk stratification of patients with known or suspected CAD without any radiation exposure, contrast media, or pharmacological vasodilator agents.
Highlights
Accurate assessment of myocardial ischemia is crucial for improving revascularization in patients with coronary artery disease (CAD)
The main findings of the present study include; (1) resting coronary sinus blood flow (CSBF) is significantly higher in patients with major adverse cardiac events (MACE) compared with those without MACE both in known and suspected CAD cohorts; (2) the annualized event rate is higher in patients with resting CSBF higher than the median value, irrespective of Late gadolinium enhancement (LGE) or perfusion findings; (3) the area under the curve (AUC) of resting CSBF is similar to that of coronary flow reserve (CFR) for predicting future MACE both in known and suspected CAD
In suspected CAD, AUC of corrected myocardial blood flow (cMBF) was similar to resting CSBF (0.83 vs. 0.82, p = 0.21) (Fig. 7). These results suggested that the resting CSBF may be useful prognostic marker, attention should be paid that many confounders may exist such as resting blood pressure, resting heart rate and left ventricular (LV) hypertrophy, especially in known CAD patients
Summary
Accurate assessment of myocardial ischemia is crucial for improving revascularization in patients with coronary artery disease (CAD). A recent study used PET to demonstrate that the resting myocardial flow is a main determinant of CFR; in that study, the resting blood flow was elevated to account for ischemia in CAD patients who underwent revascularization [9]. Based on these findings, we hypothesized that, according to PC cine CMR, the resting CSBF will be elevated in high risk CAD patients and would predict future cardiovascular events. Phase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to measure coronary sinus blood flow (CSBF) and coronary flow reserve (CFR). We aimed to compare the prognostic value of resting CSBF and CFR for predicting major adverse cardiac events (MACE) in patients with known or suspected coronary artery disease (CAD) who underwent vasodilator stress CMR
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