open access

Vol 24, No 3 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-27
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Cardiac magnetic resonance imaging derived quantification of myocardial ischemia and scar improves risk stratification and patient management in stable coronary artery disease

Dominik Buckert, Maciej Cieslik, Raid Tibi, Michael Radermacher, Wolfgang Rottbauer, Peter Bernhardt
DOI: 10.5603/CJ.a2017.0036
·
Pubmed: 28353309
·
Cardiol J 2017;24(3):293-304.

open access

Vol 24, No 3 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-27

Abstract

Background: Quantification of myocardial ischemia and necrosis might ameliorate prognostic models and lead to improved patient management. However, no standardized consensus on how to assess and quantify these parameters has been established. The aim of this study was to quantify these variables by cardiac magnetic resonance imaging (CMR) and to establish possible incremental implications in cardiovascular risk prediction.

Methods: This study is a retrospective analysis of patients with known or suspected coronary artery disease (CAD) referred for adenosine perfusion CMR was performed. Myocardial ischemia and necrosis were assessed and quantified using an algorithm based on standard first-pass perfusion imaging and late gadolinium enhancement (LGE). The combined primary endpoint was defined as cardiac death, non-fatal myocardial infarction, and stroke.

Results: 845 consecutive patients were enrolled into the study. During the median follow-up of 3.64 [1.03; 10.46] years, 61 primary endpoints occurred. Patients with primary endpoint showed larger extent of ischemia (10.7 ± 12.25% vs. 3.73 ± 8.29%, p < 0.0001) and LGE (21.09 ± 15.11% vs. 17.73 ± 10.72%, p < 0.0001). A risk prediction model containing the extent of ischemia and LGE proved to be superior in comparison to all other models (χ² increase: from 39.678 to 56.676, integrated discrimination index: 0.3851, p = 0.0033, net reclassification index: 0.11516, p = 0.0071). The ben­eficial effect of revascularization tended to be higher in patients with greater extents of ischemia, though statistical significance was not reached.

Conclusions: Quantification of myocardial ischemia and LGE was shown to significantly improve existing risk prediction models and might thus lead to an improvement in patient management.

Abstract

Background: Quantification of myocardial ischemia and necrosis might ameliorate prognostic models and lead to improved patient management. However, no standardized consensus on how to assess and quantify these parameters has been established. The aim of this study was to quantify these variables by cardiac magnetic resonance imaging (CMR) and to establish possible incremental implications in cardiovascular risk prediction.

Methods: This study is a retrospective analysis of patients with known or suspected coronary artery disease (CAD) referred for adenosine perfusion CMR was performed. Myocardial ischemia and necrosis were assessed and quantified using an algorithm based on standard first-pass perfusion imaging and late gadolinium enhancement (LGE). The combined primary endpoint was defined as cardiac death, non-fatal myocardial infarction, and stroke.

Results: 845 consecutive patients were enrolled into the study. During the median follow-up of 3.64 [1.03; 10.46] years, 61 primary endpoints occurred. Patients with primary endpoint showed larger extent of ischemia (10.7 ± 12.25% vs. 3.73 ± 8.29%, p < 0.0001) and LGE (21.09 ± 15.11% vs. 17.73 ± 10.72%, p < 0.0001). A risk prediction model containing the extent of ischemia and LGE proved to be superior in comparison to all other models (χ² increase: from 39.678 to 56.676, integrated discrimination index: 0.3851, p = 0.0033, net reclassification index: 0.11516, p = 0.0071). The ben­eficial effect of revascularization tended to be higher in patients with greater extents of ischemia, though statistical significance was not reached.

Conclusions: Quantification of myocardial ischemia and LGE was shown to significantly improve existing risk prediction models and might thus lead to an improvement in patient management.

Get Citation

Keywords

cardiac magnetic resonance imaging, quantification of ischemia and necrosis, coronary artery disease, risk stratification, prognosis and outcomes

About this article
Title

Cardiac magnetic resonance imaging derived quantification of myocardial ischemia and scar improves risk stratification and patient management in stable coronary artery disease

Journal

Cardiology Journal

Issue

Vol 24, No 3 (2017)

Pages

293-304

Published online

2017-03-27

DOI

10.5603/CJ.a2017.0036

Pubmed

28353309

Bibliographic record

Cardiol J 2017;24(3):293-304.

Keywords

cardiac magnetic resonance imaging
quantification of ischemia and necrosis
coronary artery disease
risk stratification
prognosis and outcomes

Authors

Dominik Buckert
Maciej Cieslik
Raid Tibi
Michael Radermacher
Wolfgang Rottbauer
Peter Bernhardt

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