Complementary prognostic value of stress perfusion imaging and global coronary flow reserve derived from cardiovascular magnetic resonance: a long-term cohort study

• Published in: Journal of cardiovascular magnetic resonance Vol. 25; no. 1; p. 20
• Main Authors: Nakamura, Satoshi, Ishida, Masaki, Nakata, Kei, Takafuji, Masafumi, Nakamori, Shiro, Kurita, Tairo, Ito, Haruno, Dohi, Kaoru, Sakuma, Hajime
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 16.03.2023; BioMed Central Ltd; BioMed Central; Elsevier
• Subjects: Angina; Angina pectoris; Arrhythmia; Arteriosclerosis; Atherosclerosis; Blood flow; Cardiovascular disease; Cardiovascular magnetic resonance; Cerebral infarction; Cohort analysis; Cohort Studies; Congestive heart failure; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary circulation; Coronary flow reserve; Coronary sinus; Coronary vessels; Drug dosages; Health hazards; Heart; Heart attack; Heart diseases; Heart failure; Humans; Ischemia; Long-term prognostic value; Magnetic resonance; Magnetic Resonance Imaging, Cine - methods; Magnetic Resonance Spectroscopy; Medical imaging; Microvasculature; Myocardial infarction; Myocardial ischemia; Myocardial Perfusion Imaging - methods; Patients; Perfusion; Predictive Value of Tests; Prognosis; Reclassification; Regression analysis; Risk Assessment; Risk Factors; Scanners; Stenosis; Stress; Subgroups; Velocity; Ventricle; Japan; Coronary flow reserve; Myocardial ischemia; Cardiovascular magnetic resonance; Long-term prognostic value; Coronary sinus
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-023-00930-3

Phase-contrast cine cardiovascular magnetic resonance (CMR) quantifies global coronary flow reserve (CFR) by measuring blood flow in the coronary sinus (CS), allowing assessment of the entire coronary circulation. However, the complementary prognostic value of stress perfusion CMR and global CFR in long-term follow-up has yet to be investigated. This study aimed to investigate the complementary prognostic value of stress myocardial perfusion imaging and global CFR derived from CMR in patients with suspected or known coronary artery disease (CAD) during long-term follow-up. Participants comprised 933 patients with suspected or known CAD who underwent comprehensive CMR. Major adverse cardiac events (MACE) comprised cardiac death, non-fatal myocardial infarction, unstable angina, hospitalization for heart failure, stroke, ventricular arrhythmia, and late revascularization. During follow-up (median, 5.3 years), there were 223 MACE. Kaplan–Meier curve analysis revealed a significant difference in event-free survival among tertile groups for global CFR (log-rank, p < 0.001) and between patients with and without ischemia (p < 0.001). The combination of stress perfusion CMR and global CFR enhanced risk stratification (p < 0.001 for overall), and prognoses were comparable between the subgroup with ischemia and no impaired CFR and the subgroup with no ischemia and impaired CFR (p = 0.731). Multivariate Cox proportional hazard regression analysis showed that impaired CFR remained a significant predictor for MACE (hazard ratio, 1.6; p = 0.002) when adjusted for coronary risk factors and CMR predictors, including ischemia. The addition of impaired CFR to coronary risk factors and ischemia significantly increased the global chi-square value from 88 to 109 (p < 0.001). Continuous net reclassification improvement and integrated discrimination with the addition of global CFR to coronary risk factors plus ischemia improved to 0.352 (p < 0.001) and 0.017 (p < 0.001), respectively. During long-term follow-up, stress perfusion CMR and global CFR derived from CS flow measurement provided complementary prognostic value for prediction of cardiovascular events. Microvascular dysfunction or diffuse atherosclerosis as shown by impaired global CFR may play a role as important as that of ischemia due to epicardial coronary stenosis in the risk stratification of CAD patients.