Risk stratification in patients with stable angina pectoris - adenosine perfusion cardiac magnetic resonance serves as an excellent tool concerning long-term prediction of severe clinical endpoints

Abstract

Purpose: Objective was to assess the hypothesis that cardiac magnetic resonance (CMR) myocardial perfusion imaging is able to provide prognostic value regarding the prediction of major cardiovascular events in patients presenting with stable angina pectoris. Therefore, a large, consecutive and thereby unselected cohort of patients who underwent stress CMR has been followed up to clarify the incremental prognostic benefit over other conventional risk factors. Methods: From 2003 to 2007 consecutive patients with stable angina pectoris who were referred for adenosine perfusion CMR were enrolled unless they exhibited the predefined exclusion criteria. Myocardial perfusion imaging by adenosine-stress and late gadolinium enhancement were assessed in a 1.5 T whole-body CMR-scanner. Follow-up information concerning the combined endpoint cardiac death, non-fatal myocardial infarction and stroke was gotten from the patient, the general practitioner or the treating hospital, respectively. Results: 1,229 consecutive patients were enrolled in our study. During the mean follow-up period of 4.2±2.1 years, 88 primary endpoints could be observed. Patients with a reversible perfusion deficit held significantly more cardiac deaths (p<0.0001) and non-fatal myocardial infarction (p=0.001) than patients without. Performing univariate and multivariate testing, we were able to demonstrate that the presence of a reversible perfusion deficit has to be considered as the strongest independent predictor for an adverse event with a 3-fold increased risk (Hazard ratio 2.99). Moreover, the absence of a perfusion deficit has shown to exhibit a high negative predictive value. Conclusion: In patients with stable angina pectoris, the presence of a reversible perfusion deficit diagnosed by adenosine perfusion CMR goes along with a significant higher risk concerning the occurrence of major cardiovascular events. We could demonstrate that the presence of a reversible perfusion deficit is a strong and independent variable that provides incremental information over other conventional risk factors.