P359 Dipyridamole stress cardiac magnetic resonance in the assessment of utility of coronary revascularization in patients with stable angina

• Published in: European heart journal cardiovascular imaging Vol. 21; no. Supplement_1
• Main Authors: Igual Munoz, B, Maryem Ezzitouny, M E, Elena Sanchez Lacuesta, E S L C, Jose Luis Diez Gil, J L D G, Vicente Miro Palau, V M P, Francisco Ten Morro, F T P, Maria Ferre Valverdu, M F V, Alberto Berenguer Jofesa, A B J, Jose Leandro Perez Bosca, J L P B, Rafael Paya Serrano, R P S
• Format: Journal Article
• Language: English
• Published: 01-01-2020
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jez319.208

Abstract
The prognostic impact of coronary revascularization in patients with stable angina is limited being reserved nowadays for patients with symptoms or severe ischemia in imaging tests. We propose to study the usefulness of stress CMR to assess the utility of coronary revascularization in patients with stable angina.
Methods
A retrospective cohort study was conducted including consecutive patients with inducible ischemia in dypiridamol stress CMR. Patients with acute coronary syndrome or severe valvular disease were excluded. The decision to revascularize after MRI was made by the responsible medical team following the guidelines of clinical practice. The presence of cardiovascular events (death, admission or need for new revascularization) was analyzed during follow-up. The stress cardiac MR imaging protocol included a baseline functional study (b-SSFP sequences) and after administration of 0.84 mg / kg IV dipyridamole, perfusion sequences (b-SSFP) obtained during the administration of IV gadolinium contrast and F-GRE viability sequences. Clinical data such as the severity of coronary involvement, the type of coronary revascularization and if it was complete as well as data derived from the baseline functional study of ventricular volumes, segmental contractility score, transmurality and extension of necrosis, extension of hypoperfusion and also number of segments with severe ischemia considering as such those segments with transmural hypoperfusion or stress-induced systolic dysfunction.
Results
We included 424 patients of mean age of 65+ 10 years, 182 (43%) of them had known coronary artery disease and 93 (20%) of them had pevious percutaneous revascularization. Thirty-five (8%) had left main disease and 176 (41%) multivessel disease. Twenty five patients had normal stroke volume (SV) and depressed left ventricle ejection fraction (LVEF) and 60p had normal LVEF and low SV . One hundred and seven patients of the total group were revascularized (2.5% surgically). Coronary revascularization showed a significant increase in survival only if it was complete (p <0.004). All analized data were introduced in a multivariate Cox model showing SV as the most powerfull predictor of events (OR:0.9, p = 0.04, CI: 0.96-0.99) and also that patients with indexed SV <40ml / m2 significantly improved their survival after coronary complete revascularization (p = 0.003).
Conclusions
1. SV is the most powerful predictor of events in patients with stable angina and ischemia in CRM dypiridamol stress test.
2. Patients with an SVi <40ml / m2 significantly improve their survival after coronary complete revascularization.
Abstract P359 Figure. Survival curves regarding SV