TY - JOUR
T1 - Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex
AU - Coelho-Filho, Otavio R.
AU - Seabra, Luciana F.
AU - Mongeon, Franois Pierre
AU - Abdullah, Shuaib M.
AU - Francis, Sanjeev A.
AU - Blankstein, Ron
AU - Di Carli, Marcelo F.
AU - Jerosch-Herold, Michael
AU - Kwong, Raymond Y.
N1 - Funding Information:
Dr. Kwong is in part supported by the National Institutes of Health R01HL091157. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2011/8
Y1 - 2011/8
N2 - Objectives: The major aim of this study is to test the hypothesis that stress cardiac magnetic resonance (CMR) imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. Background: Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men owing to a lack of early diagnosis and management. Numerous clinical studies have shown that stress CMR detects evidence of myocardial ischemia and infarction at high accuracy. Compared to nuclear scintigraphy, CMR is free of ionizing radiation, has high spatial resolution for imaging small hearts, and overcomes breast attenuation artifacts, which are substantial advantages when imaging women for CAD. Methods: We performed stress CMR in 405 patients (168 women, mean age 58 ± 14 years) referred for ischemia assessment. CMR techniques included cine cardiac function, perfusion imaging during vasodilating stress, and late gadolinium enhancement imaging. All patients were followed for major adverse cardiac events (MACE). Results: At a median follow-up of 30 months, MACE occurred in 36 patients (9%) including 21 cardiac deaths and 15 acute myocardial infarctions. In women, CMR evidence of ischemia (ISCHEMIA) demonstrated strong association with MACE (unadjusted hazard ratio: 49.9, p < 0.0001). While women with ISCHEMIA(+) had an annual MACE rate of 15%, women with ISCHEMIA(-) had very low annual MACE rate (0.3%), which was not statistically different from the low annual MACE rate in men with ISCHEMIA(-) (1.1%). CMR myocardial ischemia score was the strongest multivariable predictor of MACE in this cohort, for both women and men, indicating robust cardiac prognostication regardless of sex. Conclusions: In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia.
AB - Objectives: The major aim of this study is to test the hypothesis that stress cardiac magnetic resonance (CMR) imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. Background: Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men owing to a lack of early diagnosis and management. Numerous clinical studies have shown that stress CMR detects evidence of myocardial ischemia and infarction at high accuracy. Compared to nuclear scintigraphy, CMR is free of ionizing radiation, has high spatial resolution for imaging small hearts, and overcomes breast attenuation artifacts, which are substantial advantages when imaging women for CAD. Methods: We performed stress CMR in 405 patients (168 women, mean age 58 ± 14 years) referred for ischemia assessment. CMR techniques included cine cardiac function, perfusion imaging during vasodilating stress, and late gadolinium enhancement imaging. All patients were followed for major adverse cardiac events (MACE). Results: At a median follow-up of 30 months, MACE occurred in 36 patients (9%) including 21 cardiac deaths and 15 acute myocardial infarctions. In women, CMR evidence of ischemia (ISCHEMIA) demonstrated strong association with MACE (unadjusted hazard ratio: 49.9, p < 0.0001). While women with ISCHEMIA(+) had an annual MACE rate of 15%, women with ISCHEMIA(-) had very low annual MACE rate (0.3%), which was not statistically different from the low annual MACE rate in men with ISCHEMIA(-) (1.1%). CMR myocardial ischemia score was the strongest multivariable predictor of MACE in this cohort, for both women and men, indicating robust cardiac prognostication regardless of sex. Conclusions: In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia.
KW - cardiac magnetic resonance
KW - infarction
KW - major cardiac adverse events
KW - mortality
KW - myocardial ischemia
KW - women
UR - http://www.scopus.com/inward/record.url?scp=80051603236&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80051603236&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2011.04.015
DO - 10.1016/j.jcmg.2011.04.015
M3 - Article
C2 - 21835377
AN - SCOPUS:80051603236
SN - 1936-878X
VL - 4
SP - 850
EP - 861
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 8
ER -