Document Detail


Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex.
MedLine Citation:
PMID:  21835377     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The major aim of this study is to test the hypothesis that stress cardiac magnetic resonance (CMR) imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men.
BACKGROUND: Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men owing to a lack of early diagnosis and management. Numerous clinical studies have shown that stress CMR detects evidence of myocardial ischemia and infarction at high accuracy. Compared to nuclear scintigraphy, CMR is free of ionizing radiation, has high spatial resolution for imaging small hearts, and overcomes breast attenuation artifacts, which are substantial advantages when imaging women for CAD.
METHODS: We performed stress CMR in 405 patients (168 women, mean age 58 ± 14 years) referred for ischemia assessment. CMR techniques included cine cardiac function, perfusion imaging during vasodilating stress, and late gadolinium enhancement imaging. All patients were followed for major adverse cardiac events (MACE).
RESULTS: At a median follow-up of 30 months, MACE occurred in 36 patients (9%) including 21 cardiac deaths and 15 acute myocardial infarctions. In women, CMR evidence of ischemia (ISCHEMIA) demonstrated strong association with MACE (unadjusted hazard ratio: 49.9, p < 0.0001). While women with ISCHEMIA(+) had an annual MACE rate of 15%, women with ISCHEMIA(-) had very low annual MACE rate (0.3%), which was not statistically different from the low annual MACE rate in men with ISCHEMIA(-) (1.1%). CMR myocardial ischemia score was the strongest multivariable predictor of MACE in this cohort, for both women and men, indicating robust cardiac prognostication regardless of sex.
CONCLUSIONS: In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia.
Authors:
Otavio R Coelho-Filho; Luciana F Seabra; François-Pierre Mongeon; Shuaib M Abdullah; Sanjeev A Francis; Ron Blankstein; Marcelo F Di Carli; Michael Jerosch-Herold; Raymond Y Kwong
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  4     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-12     Completed Date:  2011-12-13     Revised Date:  2014-04-03    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  850-61     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Boston
Contrast Media / diagnostic use
Coronary Angiography
Coronary Circulation*
Disease-Free Survival
Female
Gadolinium DTPA / diagnostic use
Humans
Kaplan-Meier Estimate
Magnetic Resonance Imaging, Cine*
Male
Middle Aged
Myocardial Infarction / etiology*,  mortality,  physiopathology
Myocardial Ischemia / complications,  diagnosis*,  mortality,  physiopathology
Myocardial Perfusion Imaging / methods*
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Risk Assessment
Risk Factors
Sex Factors
Survival Rate
Time Factors
Vasodilator Agents / diagnostic use*
Grant Support
ID/Acronym/Agency:
R01 HL091157/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Vasodilator Agents; K2I13DR72L/Gadolinium DTPA
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2011 Aug;4(8):924-5   [PMID:  21835390 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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