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PROGNOSTIC VALUE OF DIPYRIDAMOLE STRESS CMR IN PATIENTS WITH KNOWN OR SUSPECTED CORONARY ARTERY DISEASE: A LONG TERM FOLLOW-UP STUDY
Antonella Meloni1, Cinzia Nugara2, Maria Vaccaro3, Chrysanthos Grigoratos1, Giancarlo Todiere1, Andrea Barison1, Daniele De Marchi1, Giuseppina Novo2, Giovanni Donato Aquaro1, and Alessia Pepe1

1Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy, 2Università degli Studi di Palermo, Palermo, Italy, 3Università degli Studi di Messina, Messina, Italy

Synopsis

We determined the long-term prognostic value of dipyridamole stress-CMR in patients with known or suspected coronary artery disease (CAD). Reversible perfusion deficit and diabetes identified patients at high risk of fatal and non fatal cardiac events. Myocardial fibrosis was a strong predictor for death.

Introduction

Dipyridamole stress CMR provides detailed information on the key phases (perfusion and wall motion) of the ischemic cascade. Although the diagnostic value of stress CMR has been assessed1,2, further studies are needed to evaluate its prognostic role at long-term, specifically using dipyridamole where no data are available to our knowledge. So, the aim of this study was to determine the long-term prognostic value of dipyridamole stress-CMR in patients with known or suspected coronary artery disease (CAD).

Methods

Two hundred and forty-six consecutive patients (61 females, main age 61.96±10.05 years) who underwent dipyridamole stress-CMR in a high volume CMR Laboratory were considered. Abnormal wall motion at rest and after dipyridamole, perfusion at stress and at rest, and late gadolinium enhancement (LGE) were analysed.

End-points were "major non-fatal cardiac events" (ventricular arrhythmias, coronary syndromes, heart failure hospitalization ) and cardiac death.

Results

An abnormal stress CMR was found in 65 (26.4%) patients; 39 patients had a reversible stress perfusion defect in at least one myocardial segment and 26 a reversible stress perfusion defect plus worsening of stress wall motion in comparison with rest. Patients with abnormal stress CMR were significantly older and had a significant higher frequency of myocardial fibrosis (Table 1).

During a median follow up of 60.59 months (IQ range 41.98 months), 69 patients (28.0%) experienced major nonfatal cardiac events. LGE, reversible perfusion deficit, age, diabetes and family history were univariate prognosticators. In the multivariate analysis the independent predictive factors were reversible perfusion deficit (hazard ratio-HR=2.21, P=0.001) and diabetes (HR=2.21, P=0.003).

Ten patients died during follow-up and reversible motion abnormality and LGE were univariate prognosticators. At multivariate analysis, LGE remained a significant prognosticator (HR=10.83, P=0.026), after adjusting for age and diabetes.

When the composite end-point (cardiac events + death) was considered, both myocardial fibrosis and reversible perfusion deficit resulted to be significant univariate prognosticators, in addition to age, diabetes and family history. At multivariate analysis the independent predictive factors were reversible perfusion deficit (HR=2.26, P<0.0001) and diabetes (HR=2.59, P<0.0001) (Figure 1).

Conclusions

Reversible perfusion deficit and diabetes identify patients at high risk of fatal and non fatal cardiac events. LGE is a strong predictor for death in patients with known or suspected CAD.

Acknowledgements

No acknowledgement found.

References

1. Pontone G, Andreini D, Bertella E, et al. Eur Radiol. 2016;26(7):2155-2165.

2. Bodi V, Sanchis J, Lopez-Lereu MP,et al. J Am Coll Cardiol. 2007;50(12):1174-1179.

Figures

Table 1

Figure 1

Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)
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