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Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events.

Publication ,  Journal Article
Indorkar, R; Kwong, RY; Romano, S; White, BE; Chia, RC; Trybula, M; Evans, K; Shenoy, C; Farzaneh-Far, A
Published in: JACC Cardiovasc Imaging
August 2019

OBJECTIVES: The aim of this study was to evaluate the incremental prognostic value of global coronary flow reserve (CFR) in patients with known or suspected coronary artery disease who were undergoing stress cardiac magnetic resonance (CMR) imaging. BACKGROUND: Coronary microvascular dysfunction results in impaired global CFR and is implicated in the development of both atherosclerosis and heart failure. Although noninvasive assessment of CFR with positron emission tomography provides independent prognostic information, the incremental prognostic value of CMR-derived CFR remains unclear. METHODS: Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 507). Coronary sinus flow was measured using phase-contrast imaging at baseline (pre) and immediately after stress (peak) perfusion. CFR was calculated as the ratio of peak to pre-flow. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between CFR and MACE. The incremental prognostic value of CFR was assessed in nested models. RESULTS: Over a median follow-up of 2.1 years, 80 patients experienced MACE. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with CFR lower than the median (2.2) (log-rank p < 0.001); this remained significant after adjustment for the presence of ischemia and late gadolinium enhancement (LGE) (log-rank p < 0.001). CFR was significantly associated with the risk of MACE after adjustment for clinical and imaging risk factors, including ischemia extent, ejection fraction, and LGE size (hazard ratio: 1.238; p = 0.018). Addition of CFR in this model resulted in significant improvement in the C-index (from 0.70 to 0.75; p = 0.0087) and a continuous net reclassification improvement of 0.198 (95% confidence interval: 0.120 to 0.288). CONCLUSIONS: CMR-derived CFR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and CMR risk factors. These findings suggest a role for CMR-derived CFR in identifying patients at risk of adverse events following stress CMR, even in the absence of ischemia and LGE.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

August 2019

Volume

12

Issue

8 Pt 2

Start / End Page

1686 / 1695

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Perfusion Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
 

Citation

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Indorkar, R., Kwong, R. Y., Romano, S., White, B. E., Chia, R. C., Trybula, M., … Farzaneh-Far, A. (2019). Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events. JACC Cardiovasc Imaging, 12(8 Pt 2), 1686–1695. https://doi.org/10.1016/j.jcmg.2018.08.018
Indorkar, Raksha, Raymond Y. Kwong, Simone Romano, Brent E. White, Richard C. Chia, Michael Trybula, Kaleigh Evans, Chetan Shenoy, and Afshin Farzaneh-Far. “Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events.JACC Cardiovasc Imaging 12, no. 8 Pt 2 (August 2019): 1686–95. https://doi.org/10.1016/j.jcmg.2018.08.018.
Indorkar R, Kwong RY, Romano S, White BE, Chia RC, Trybula M, et al. Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events. JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1686–95.
Indorkar, Raksha, et al. “Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events.JACC Cardiovasc Imaging, vol. 12, no. 8 Pt 2, Aug. 2019, pp. 1686–95. Pubmed, doi:10.1016/j.jcmg.2018.08.018.
Indorkar R, Kwong RY, Romano S, White BE, Chia RC, Trybula M, Evans K, Shenoy C, Farzaneh-Far A. Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events. JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1686–1695.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

August 2019

Volume

12

Issue

8 Pt 2

Start / End Page

1686 / 1695

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Perfusion Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine