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Hard cardiac events in high-risk patients identified with MRI
Korosoglou G. J Am Coll Cardiol. 2011;58:1140-1149.
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Patients at high risk for future hard cardiac events and revascularization procedures can be accurately identified with assessment of myocardial strain response on strain-encoded MRI, according to a study.
From January 2006 to December 2009, 320 patients with suspected or known CAD underwent dobutamine stress MRI. At the time of imaging, arterial hypertension, hyperlipidemia, current or prior smoking, diabetes mellitus and family history of CAD were recorded, as well as total number of atherogenic risk factors and Duke clinical score, according to the study.
Researchers assessed wall motion abnormalities (WMA) and myocardial strain at baseline and during stress. In a pretest, patients were categorized into probability groups for low (<30%), intermediate (30%-70%) or high (>70%) CAD, according to the study. Any cardiac deaths, nonfatal MI and revascularization procedures performed more than 90 days after magnetic resonance were collected as part of the outcome data.
In 62% of patients, coronary angiography showed 50% or less stenosis, according to the study. Higher accuracy for CAD detection was found in strain-encoded MRI (P<.02) vs. specificity (88% vs. 94%) and accuracy (93% vs. 88%). Researchers were able to associate a higher rate of hard events and revascularization procedures with inducible WMA and strain defects. There was also a higher rate for hard cardiac events in patients with resting WMA, with a biphasic response during stress testing representing a worse outcome. However, researchers found inducible WMA to be predictive of hard cardiac events in patients with and without resting WMA. During the follow-up period, 10 cardiac deaths, 25 nonfatal MI, 32 coronary revascularizations, 32 late revascularizations and 41 early revascularizations occurred.
Disclosure: Dr. Korosoglou reports no relevant financial disclosures.
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This is the third in a series of reports by this group that have shown that dobutamine stress strain-encoded cardiac MRI can detect ischemia at lower stress levels than conventional wall motion imaging, improve diagnostic performance and, in this report, improve risk stratification for future events. The results are more compelling than those reported for any of the echo strain rate methods and hold promise of a real advance in noninvasive evaluation of patients with known or suspected CAD.
– Nathaniel Reichek, MD, FACC, FAHA
Cardiology Today Editorial Board member
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