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Cardiac MRI may have prognostic value for recent MI, suspected CAD
In patients with recent MI or known or suspected CAD, cardiac MRI may have prognostic utility, allowing risk stratification and appropriate preventive strategies, according to recent study results.
Most notably, left ventricular ejection fraction appears to be predictive of future CV events in these patients.
Researchers evaluated data from 56 studies that included 25,947 patients collected from a systematic literature search of the PubMed and EMBASE electronic databases. Of these studies, 27 assessed patients with recent MI and 29 involved patients with confirmed or suspected CAD. The investigators reviewed the studies for correlations between cardiac MRI findings (LVEF, inducible wall motion abnormalities, abnormal myocardial perfusion, microvascular obstruction, late gadolinium enhancement, edema or intramyocardial hemorrhage) and hard events (all-cause or cardiac death, cardiac transplantation or MI), as well as major adverse CV events.
Only five studies evaluated hard events, and none of the relevant cardiac MRI findings were assessed in more than 1,000 patients. For this reason, the researchers could not determine an association between findings from cardiac MRI and hard events in patients with recent MI.
Among 27 studies that analyzed the correlation between cardiac MRI and major adverse CV events in a total of 5,057 patients (n=888 events), multivariable analysis indicated that LVEF was an independent predictor of major events in more than half of the studies, with adjusted HRs ranging from 1.03 to 1.05 per percent decrease. Available evidence was insufficient to determine the prognostic value of other findings from cardiac MRI.
Among 24 studies of 18,212 patients with confirmed or suspected CAD (n=958 events), cardiac MRI findings independently associated with hard events included inducible wall motion abnormalities (adjusted HR range: 1.87-2.99), inducible perfusion defects (adjusted HR range: 3.02-7.77), LVEF (adjusted HR range: 0.72-0.82 per 10% increase) and infarction (adjusted HR range: 2.82-9.43). The presence of inducible perfusion defects in patients with known or suspected CAD also was associated with major adverse cardiac events in analysis of 18 studies of 12,847 patients (adjusted HR range: 1.76-3.21).
“This report is among the first comprehensive systematic reviews investigating the independent prognostic value of different [cardiac MRI] findings and the risk of future CV events,” the researchers wrote. “… Cardiac MRI is capable of providing independent prognostic information that allows for risk stratification after MI, as well as in patients with suspected or known CAD.”
Disclosure: The researchers report no relevant financial disclosures.