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Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry.

Publication ,  Journal Article
Heydari, B; Ge, Y; Antiochos, P; Islam, S; Steel, K; Bingham, S; Abdullah, S; Mikolich, JR; Arai, AE; Bandettini, WP; Patel, AR; Shanbhag, SM ...
Published in: JACC Cardiovasc Imaging
June 2023

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations. OBJECTIVES: In this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD. METHODS: Sex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) Registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting. RESULTS: SPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality. CONCLUSIONS: Stress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891).

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

June 2023

Volume

16

Issue

6

Start / End Page

749 / 764

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Registries
  • Prognosis
  • Predictive Value of Tests
  • Perfusion
  • Myocardial Perfusion Imaging
  • Myocardial Ischemia
  • Myocardial Infarction
  • Male
  • Magnetic Resonance Imaging, Cine
 

Citation

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Heydari, B., Ge, Y., Antiochos, P., Islam, S., Steel, K., Bingham, S., … Kwong, R. Y. (2023). Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry. JACC Cardiovasc Imaging, 16(6), 749–764. https://doi.org/10.1016/j.jcmg.2022.11.025
Heydari, Bobak, Yin Ge, Panagiotis Antiochos, Sabeeh Islam, Kevin Steel, Scott Bingham, Shuaib Abdullah, et al. “Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry.JACC Cardiovasc Imaging 16, no. 6 (June 2023): 749–64. https://doi.org/10.1016/j.jcmg.2022.11.025.
Heydari B, Ge Y, Antiochos P, Islam S, Steel K, Bingham S, et al. Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry. JACC Cardiovasc Imaging. 2023 Jun;16(6):749–64.
Heydari, Bobak, et al. “Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry.JACC Cardiovasc Imaging, vol. 16, no. 6, June 2023, pp. 749–64. Pubmed, doi:10.1016/j.jcmg.2022.11.025.
Heydari B, Ge Y, Antiochos P, Islam S, Steel K, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Shanbhag SM, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Raman SV, Ferrari VA, Shah DJ, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry. JACC Cardiovasc Imaging. 2023 Jun;16(6):749–764.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

June 2023

Volume

16

Issue

6

Start / End Page

749 / 764

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Registries
  • Prognosis
  • Predictive Value of Tests
  • Perfusion
  • Myocardial Perfusion Imaging
  • Myocardial Ischemia
  • Myocardial Infarction
  • Male
  • Magnetic Resonance Imaging, Cine