Prognostic Value of Stress Cardiac Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-Analysis

• Published in: Journal of the American College of Cardiology Vol. 62; no. 9; pp. 826 - 838
• Main Authors: LIPINSKI, Michael J, MCVEY, Courtney M, BERGER, Jeffrey S, KRAMER, Christopher M, SALERNO, Michael
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 27-08-2013
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary heart disease; Female; Follow-Up Studies; Gadolinium; Heart; Humans; Image Enhancement - methods; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Prognosis; Risk Assessment; Predictive value; Medical imagery; Cardiovascular disease; Systematic review; Circulatory system; Diagnosis; Cardiology; Coronary heart disease; Nuclear magnetic resonance imaging; Stress; Metaanalysis; coronary artery disease; OR; cardiac magnetic resonance imaging; CAD; myocardial infarction; major adverse cardiovascular event(s); CMR; LGE; odds ratio; prognosis; AER; annualized event rate; MACE; stress cardiac MRI; myocardial perfusion; late gadolinium enhancement; MI
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.03.080

This study sought to perform a systematic review and meta-analysis to understand the role of stress cardiac magnetic resonance imaging (CMR) in assessing cardiovascular prognosis in patients with known or suspected coronary artery disease (CAD).
Although stress CMR is excellent for the diagnosis of obstructive CAD, the prognostic value of stress CMR has been less well described.
PubMed, Cochrane CENTRAL, and metaRegister of Controlled Trials were searched for stress CMR studies with >6 months of prognostic data. Primary endpoints were cardiovascular death, myocardial infarction (MI), and a composite outcome of cardiovascular death or MI during follow-up. Summary effect estimates were generated with random-effects modeling, and annualized event rates were assessed.
Nineteen studies (14 vasodilator, 4 dobutamine, and 1 that used both) involved a total of 11,636 patients with a mean follow-up of 32 months. Patients had a mean age of 63 ± 12 years, 63% were male, and 26% had previous MI; mean left ventricular ejection fraction was 61 ± 12%; and late gadolinium enhancement was present in 29% and ischemia in 32%. Patients with ischemia had a higher incidence of MI (odds ratio [OR]: 7.7; p < 0.0001), cardiovascular death (OR: 7.0; p < 0.0001), and the combined endpoint (OR: 6.5; p < 0.0001) compared with those with a negative study. The combined outcome annualized events rates were 4.9% for a positive versus 0.8% for a 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 late gadolinium enhancement was also significantly associated with a worse prognosis.
A negative stress CMR study is associated with very low risk of cardiovascular death and MI. Stress CMR has excellent prognostic characteristics and may help guide risk stratification of patients with known or suspected CAD.