Skip to main content
Erschienen in: European Radiology 7/2016

29.10.2015 | Cardiac

Prognostic value of dipyridamole stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a mid-term follow-up study

verfasst von: Gianluca Pontone, Daniele Andreini, Erika Bertella, Monica Loguercio, Marco Guglielmo, Andrea Baggiano, Giovanni Donato Aquaro, Saima Mushtaq, Sara Salerni, Paola Gripari, Carmen Rossi, Chiara Segurini, Edoardo Conte, Virginia Beltrama, Marta Giovannardi, Fabrizio Veglia, Andrea Igoren Guaricci, Antonio L. Bartorelli, Piergiuseppe Agostoni, Mauro Pepi, Pier Giorgio Masci

Erschienen in: European Radiology | Ausgabe 7/2016

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Dipyridamole stress cardiac magnetic resonance (CMR) evaluates the key phases (perfusion and wall motion) of the ischemic cascade. We sought to determine the prognostic value of dipyridamole stress-CMR in consecutive patients symptomatic for chest pain.

Methods

Seven hundred and ninety-three consecutive patients symptomatic for chest pain underwent dipyridamole stress-CMR and were followed up for 810 ± 665 days. Patients were classified in group 1 (no- reversible ischemia), group 2 (stress perfusion defect alone), and group 3 [stress perfusion defect plus abnormal wall motion (AWM)]. End points were "all cardiac events" (myocardial infarction, cardiac death and revascularization) and "hard cardiac events" (all cardiac events excluding revascularization).

Results

One hundred and ninety-five (24 %) all cardiac events and 53 (7 %) hard cardiac events were observed. All and hard cardiac event rates in groups 1, 2, and 3 were 11 %, 49 %, 69 % and 4 %, 8 %, 21 %, respectively, with a higher rate in group 2 vs. group 1 (p<0.01) and group 3 vs. groups 1 and 2 (p<0.01). Multivariate analysis showed the presence of late gadolinium enhancement and stress perfusion defect plus AWM as independent predictors of all and hard cardiac events.

Conclusions

Dipyridamole stress-CMR improves prognostic stratification of patients through differentiation between the different components of the ischemic cascade.

Key Points

Dipyridamole stress cardiac magnetic resonance helps to assess coronary artery disease.
Novel technique to study the key phases of myocardial ischemia.
Combined assessment of perfusion and motion defects.
Dipyridamole stress imaging has additional value for predicting cardiac events.
Literatur
1.
Zurück zum Zitat Shaw LJ, Berman DS, Maron DJ, Mancini GBJ, Hayes SW, Hartigan PM et al (2008) COURAGE Investigators. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117:1283–1291CrossRefPubMed Shaw LJ, Berman DS, Maron DJ, Mancini GBJ, Hayes SW, Hartigan PM et al (2008) COURAGE Investigators. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117:1283–1291CrossRefPubMed
2.
Zurück zum Zitat Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV et al (2010) Low diagnostic yield of elective coronary angiography. N Engl J Med 362:886–895CrossRefPubMedPubMedCentral Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV et al (2010) Low diagnostic yield of elective coronary angiography. N Engl J Med 362:886–895CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H et al (2008) MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J 29:480–489CrossRefPubMed Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H et al (2008) MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J 29:480–489CrossRefPubMed
4.
Zurück zum Zitat Greenwood JP, Motwani M, Maredia N, Brown JM, Everett CC, Nixon J et al (2012) Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 379:453–460CrossRefPubMedPubMedCentral Greenwood JP, Motwani M, Maredia N, Brown JM, Everett CC, Nixon J et al (2012) Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 379:453–460CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K et al (2013) MR-IMPACT. Investigators. MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial. Eur Heart J 34:775–781CrossRefPubMed Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K et al (2013) MR-IMPACT. Investigators. MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial. Eur Heart J 34:775–781CrossRefPubMed
6.
Zurück zum Zitat Lipinski MJ, McVey CM, Berger JS, Kramer CM, Salerno M (2013) Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis. J Am Coll Cardiol 62:826–838CrossRefPubMed Lipinski MJ, McVey CM, Berger JS, Kramer CM, Salerno M (2013) Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis. J Am Coll Cardiol 62:826–838CrossRefPubMed
7.
Zurück zum Zitat Pontone G, Andreini D, Bartorelli AL, Bertella E, Cortinovis S, Mushtaq et al (2013) A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD. JACC Cardiovasc Imaging 6:641–650CrossRefPubMed Pontone G, Andreini D, Bartorelli AL, Bertella E, Cortinovis S, Mushtaq et al (2013) A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD. JACC Cardiovasc Imaging 6:641–650CrossRefPubMed
8.
Zurück zum Zitat Kramer CM, Barkhausen J, Flamm SD, Raymond JK, Nagel E (2008) Society for Cardiovascular Magnetic Resonance Board of Trustees Task Force on Standardized Protocols. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 10:35CrossRefPubMedPubMedCentral Kramer CM, Barkhausen J, Flamm SD, Raymond JK, Nagel E (2008) Society for Cardiovascular Magnetic Resonance Board of Trustees Task Force on Standardized Protocols. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 10:35CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S et al (2006) Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 113:2733–2743CrossRefPubMed Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S et al (2006) Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 113:2733–2743CrossRefPubMed
10.
Zurück zum Zitat Gerber BL, Raman SV, Nayak K, Epstein FH, Ferreira P, Axel L et al (2008) Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art. J Cardiovasc Magn Reson 10:18CrossRefPubMedPubMedCentral Gerber BL, Raman SV, Nayak K, Epstein FH, Ferreira P, Axel L et al (2008) Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art. J Cardiovasc Magn Reson 10:18CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Nandalur KR, Dwamena BA, Choudhri AF, Nandalur MR, Carlos RC (2007) Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol 50:1343–1353CrossRefPubMed Nandalur KR, Dwamena BA, Choudhri AF, Nandalur MR, Carlos RC (2007) Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol 50:1343–1353CrossRefPubMed
12.
Zurück zum Zitat Nagel E, Lehmkuhl HB, Bocksch W, Klein C, Vogel U, Frantz E et al (1999) Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 99:763–770CrossRefPubMed Nagel E, Lehmkuhl HB, Bocksch W, Klein C, Vogel U, Frantz E et al (1999) Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 99:763–770CrossRefPubMed
13.
Zurück zum Zitat Macwar RR, Williams BA, Shirani J (2013) Prognostic value of adenosine cardiac magnetic resonance imaging in patients presenting with chest pain. Am J Cardiol 112:46–50CrossRefPubMed Macwar RR, Williams BA, Shirani J (2013) Prognostic value of adenosine cardiac magnetic resonance imaging in patients presenting with chest pain. Am J Cardiol 112:46–50CrossRefPubMed
14.
Zurück zum Zitat Buckert D, Dewes P, Walcher T, Rottbauer W, Bernhardt P (2013) Intermediate-term Prognostic value of reversible perfusion deficit diagnosed by adenosine CMR: a prospective follow-up study in a consecutive patient population. JACC Cardiovasc Imaging 6:56–63CrossRefPubMed Buckert D, Dewes P, Walcher T, Rottbauer W, Bernhardt P (2013) Intermediate-term Prognostic value of reversible perfusion deficit diagnosed by adenosine CMR: a prospective follow-up study in a consecutive patient population. JACC Cardiovasc Imaging 6:56–63CrossRefPubMed
15.
Zurück zum Zitat Coelho-Filho OR, Seabra LF, Mongeon FP, Abdullah SM, Francis SA, Blankstein R et al (2011) Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex. JACC Cardiovasc Imaging 4:850–861CrossRefPubMedPubMedCentral Coelho-Filho OR, Seabra LF, Mongeon FP, Abdullah SM, Francis SA, Blankstein R et al (2011) Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex. JACC Cardiovasc Imaging 4:850–861CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Kelle S, Chiribiri A, Vierecke J, Egnell C, Hamdan A, Jahnke C et al (2011) Long-term prognostic value of dobutamine stress CMR. JACC Cardiovasc Imaging 4:161–172CrossRefPubMed Kelle S, Chiribiri A, Vierecke J, Egnell C, Hamdan A, Jahnke C et al (2011) Long-term prognostic value of dobutamine stress CMR. JACC Cardiovasc Imaging 4:161–172CrossRefPubMed
17.
Zurück zum Zitat Wallace EL, Morgan TM, Walsh TF, Dall’Armellina E, Ntim W, Hamilton CA et al (2009) Dobutamine cardiac magnetic resonance results predict cardiac prognosis in women with known or suspected ischemic heart disease. JACC Cardiovasc Imaging 2:299–307CrossRefPubMedPubMedCentral Wallace EL, Morgan TM, Walsh TF, Dall’Armellina E, Ntim W, Hamilton CA et al (2009) Dobutamine cardiac magnetic resonance results predict cardiac prognosis in women with known or suspected ischemic heart disease. JACC Cardiovasc Imaging 2:299–307CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Bodi V, Sanchis J, Lopez-Lereu MP, Nunez J, Mainar L, Monmeneu JV et al (2007) Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol 50:1174–1179CrossRefPubMed Bodi V, Sanchis J, Lopez-Lereu MP, Nunez J, Mainar L, Monmeneu JV et al (2007) Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol 50:1174–1179CrossRefPubMed
19.
Zurück zum Zitat Bodí V, Rumiz E, Merlos P, Nunez J, Lopez-Lereu MP, Monmeneu JV et al (2011) One-week and 6-month cardiovascular magnetic resonance outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Rev Esp Cardiol 64:111–120CrossRefPubMed Bodí V, Rumiz E, Merlos P, Nunez J, Lopez-Lereu MP, Monmeneu JV et al (2011) One-week and 6-month cardiovascular magnetic resonance outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Rev Esp Cardiol 64:111–120CrossRefPubMed
20.
Zurück zum Zitat Elhendy A, Geleijnse ML, Roelandt JR, van Domburg RT, TenCate FJ, Comel JH et al (1996) Dobutamine-induced hypoperfusion without transient wall motion abnormalities: less severe ischemia or less severe stress? J Am Coll Cardiol 27:323–329CrossRefPubMed Elhendy A, Geleijnse ML, Roelandt JR, van Domburg RT, TenCate FJ, Comel JH et al (1996) Dobutamine-induced hypoperfusion without transient wall motion abnormalities: less severe ischemia or less severe stress? J Am Coll Cardiol 27:323–329CrossRefPubMed
21.
Zurück zum Zitat Nasis A, Ko BS, Leung MC, Antonis PR et al (2013) Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study. Eur Radiol 23:1812–1821CrossRefPubMed Nasis A, Ko BS, Leung MC, Antonis PR et al (2013) Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study. Eur Radiol 23:1812–1821CrossRefPubMed
Metadaten
Titel
Prognostic value of dipyridamole stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a mid-term follow-up study
verfasst von
Gianluca Pontone
Daniele Andreini
Erika Bertella
Monica Loguercio
Marco Guglielmo
Andrea Baggiano
Giovanni Donato Aquaro
Saima Mushtaq
Sara Salerni
Paola Gripari
Carmen Rossi
Chiara Segurini
Edoardo Conte
Virginia Beltrama
Marta Giovannardi
Fabrizio Veglia
Andrea Igoren Guaricci
Antonio L. Bartorelli
Piergiuseppe Agostoni
Mauro Pepi
Pier Giorgio Masci
Publikationsdatum
29.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 7/2016
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4064-x

Weitere Artikel der Ausgabe 7/2016

European Radiology 7/2016 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.