Prognostic value of stress cardiac magnetic resonance at 3 Tesla in patients with known or suspected coronary artery disease

Abstract

Abstract Background Adenosine stress cardiac magnetic resonance imaging (adenosine stress CMR) is increasingly playing a role in the non-invasive test for the diagnosis of coronary artery disease (CAD). But there are limited data on the prognostic value of predicting CAD-related death and major cardiac events (MACE) by adenosine stress CMR at 3 Tesla in Thailand. Objectives This study aimed to assess the prognostic value of adenosine stress CMR at 3 Tesla to predict CAD-related death, MACE, and all-cause mortality during two years in patients with known or suspected CAD. Methods This is a single-center retrospective cohort study in patients with suspected or known CAD who underwent adenosine stress CMR at 3 Tesla between 1 September 2017 to 31 August 2019 at our hospital. The data were collected from electronic medical record reviews. Only patients who completed two years of follow-up or had events were included in this study. Results A total of 633 patients were analyzed (age 66.21±12.60 years, 53.7% male, 31.9% known CAD), within two years of follow-up, we observed 15 deaths (2.4%) occurred with 5 CAD-related death (0.8%) and 10 non-fatal myocardial ischemia (non-fatal MI) (1.6%). The presence of ischemia in adenosine stress CMR at 3 Tesla is associated with CAD-related death, but the events rates of acute MI are about the same in both groups (1.4% vs. 1.7%). Patients who underwent CAG after CMR were analyzed and categorized into normal coronary arteries, insignificant CAD, and significant CAD groups. Divided the positive adenosine stress CMR group to 6.8%, 7.7%, 85.5%, and the negative adenosine stress CMR group to 15.4%, 38.5%, 42.6%, respectively. So, the adenosine stress CMR at 3 Tesla has sensitivity at 94.34%, Specificity 29.17%, PPV 85.47%, and NPV 53.85%. Conclusions In this cohort study, patients with positive adenosine stress CMR were associated with an increased risk of CAD-related death. High-risk patients who received revascularization had a good prognosis as those with a negative adenosine stress perfusion CMR. Therefore, adenosine stress CMR at 3 Tesla is an effective tool with high sensitivity and positive predictive value for identifying high-risk patients for further treatment and procedures. Funding Acknowledgement Type of funding sources: None.