Prognostic Value of Stress Cardiac Magnetic Resonance Imaging in Patients with Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-Analysis.
J Am Coll Cardiol. 2013 May 29;
Authors: Lipinski MJ, McVey CM, Berger JS, Kramer CM, Salerno M
OBJECTIVES: We performed systematic review and meta-analysis to understand the role of stress CMR in assessing cardiovascular prognosis in patients with known or suspected CAD. BACKGROUND: While stress cardiac magnetic resonance imaging (CMR) is excellent for the diagnosis of obstructive coronary artery disease (CAD), the prognostic value of stress CMR is less well described METHODS: PubMed, CENTRAL, and mRCT were searched for stress CMR studies with greater than 6 months of prognostic data. Primary end-points were cardiovascular mortality, myocardial infarction (MI), and the combined endpoint. Summary effect estimates were generated with random-effect modeling and annualized event rates were assessed. RESULTS: Nineteen studies (14 vasodilator, 4 dobutamine, and 1 that used both) had a total of 11,636 patients and a mean follow-up of 32 months. Patients had a mean age of 63 ± 12 years, 63% were male, 26% with prior MI, LV ejection fraction of 61 ± 12%, late gadolinium enhancement (LGE) in 29%, and ischemia in 32%. Patients with ischemia had a higher incidence of MI (OR 7.7, p<0.0001), cardiovascular death (OR 7.0, p<0.0001), and the combined endpoint (OR 6.5, p<0.0001) as compared with those with a negative study. The combined outcome annualized events rates were 4.9% for a positive versus 0.8% for negative stress CMR(p<0.0001), 2.8% versus 0.3% for cardiovascular death (p<0.0001), and 2.6% versus 0.4% for MI (p<0.0005). The presence of LGE also was significantly associated with worse prognosis. CONCLUSION: A negative stress CMR study is associated with very low risk of cardiovascular death and myocardial infarction. Stress CMR has excellent prognostic characteristics and may help guide risk stratification of patients with known or suspected CAD.
PMID: 23727209 [PubMed - as supplied by publisher]