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Stress cardiac MRI exams identify fatal CAD risk
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Stress cardiac MRI exam results were associated with mortality in patients with known or suspected CAD, according to findings published in JAMA Cardiology.
Robert M. Judd, PhD, co-director of the Duke Cardiovascular Magnetic Resonance Center in Durham, North Carolina, and colleagues analyzed data from a multicenter study of patients undergoing clinical evaluation of myocardial ischemia to determine whether clinical vasodilator stress cardiac MRI results were associated with patient mortality.
“We’ve known for some time that [cardiac MRI] is effective at diagnosing coronary artery disease, but it’s still not commonly used in this country,” Judd said in a press release. “One of the impediments to broader use has been a lack of data on its predictive value — something competing technologies have. Our study provides some clarity, although direct comparisons between [cardiac MRI] and other technologies would be definitive.”
The researchers analyzed data from 9,151 patients (median age, 63 years; 55% men; median BMI, 29 kg/m2) with 48,615 patient-years of follow-up.
Judd and colleagues identified 4,408 patients who underwent normal stress cardiac MRI examination and 4,743 who had an abnormal examination. During a median follow-up time of 5 years, 1,517 patients died.
The addition of cardiac MRI improved prediction of mortality in two different risk models (model 1 HR = 1.83; 95% CI, 1.63-2.06; model 2 HR = 1.8; 95% CI, 1.6-2.03), the researchers reported.
There was also improved risk reclassification when cardiac MRI was added to the models (net improvement = 11.4%; 95% CI, 7.3-13.6).
The Kaplan-Meier estimate for survival analysis after adjustment for patient age, sex and cardiac risk factors identified an association between abnormal stress cardiac MRI and mortality in all patients (HR = 1.883; 95% CI, 1.68-2.112). Mortality in patients with a history of CAD was greater (HR = 1.955; 95% CI, 1.712-2.223) compared with patients without a history of CAD (HR = 1.578; 95% CI, 1.235-2.2018).
According to the researchers, patients with normal left ventricular ejection fraction had a lower mortality rate (HR = 1.385; 95% CI, 1.194-1.606) compared with patients with abnormal LVEF (HR = 1.836; 95% CI, 1.299-2.594).
“There are a number of reasons for the limited use of stress [cardiac MRI], including the availability of good, quality laboratories, exclusion of patients who cannot undergo magnetization and a lack of data on patient outcomes,” Judd said in the release. “With the findings from this study suggesting that stress [cardiac MRI] is effective predicting mortality, we provide a strong basis for a head-to-head study between stress [cardiac MRI] and other modalities.” – by Earl Holland Jr.
Disclosures: Judd reports he received grants from the NIH and financial support from Heart Imaging Technologies. Please see the study for all others authors’ relevant financial disclosures.
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