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Fu Q, Alabed S, Hoole SP, Abraham G, Weir-McCall JR. Prognostic Value of Stress Perfusion Cardiac MRI in Cardiovascular Disease: A Systematic Review and Meta-Analysis of the Effects of the Scanner, Stress Agent, and Analysis Technique. Radiol Cardiothorac Imaging 2024; 6:e230382. [PMID: 38814186 PMCID: PMC11211944 DOI: 10.1148/ryct.230382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
Purpose To perform a systematic review and meta-analysis to assess the prognostic value of stress perfusion cardiac MRI in predicting cardiovascular outcomes. Materials and Methods A systematic literature search from the inception of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure until January 2023 was performed for articles that reported the prognosis of stress perfusion cardiac MRI in predicting cardiovascular outcomes. The quality of included studies was assessed using the Quality in Prognosis Studies tool. Reported hazard ratios (HRs) of univariable regression analyses with 95% CIs were pooled. Comparisons were performed across different analysis techniques (qualitative, semiquantitative, and fully quantitative), magnetic field strengths (1.5 T vs 3 T), and stress agents (dobutamine, adenosine, and dipyridamole). Results Thirty-eight studies with 58 774 patients with a mean follow-up time of 53 months were included. There were 1.9 all-cause deaths and 3.5 major adverse cardiovascular events (MACE) per 100 patient-years. Stress-inducible ischemia was associated with a higher risk of all-cause mortality (HR: 2.55 [95% CI: 1.89, 3.43]) and MACE (HR: 3.90 [95% CI: 2.69, 5.66]). For MACE, pooled HRs of qualitative, semiquantitative, and fully quantitative methods were 4.56 (95% CI: 2.88, 7.22), 3.22 (95% CI: 1.60, 6.48), and 1.78 (95% CI: 1.39, 2.28), respectively. For all-cause mortality, there was no evidence of a difference between qualitative and fully quantitative methods (P = .79). Abnormal stress perfusion cardiac MRI findings remained prognostic when subgrouped based on underlying disease, stress agent, and field strength, with HRs of 3.54, 2.20, and 3.38, respectively, for all-cause mortality and 3.98, 3.56, and 4.21, respectively, for MACE. There was no evidence of subgroup differences in prognosis between field strengths or stress agents. There was significant heterogeneity in effect size for MACE outcomes in the subgroups assessing qualitative versus quantitative stress perfusion analysis, underlying disease, and field strength. Conclusion Stress perfusion cardiac MRI is valuable for predicting cardiovascular outcomes, regardless of the analysis method, stress agent, or magnetic field strength used. Keywords: MR-Perfusion, MRI, Cardiac, Meta-Analysis, Stress Perfusion, Cardiac MR, Cardiovascular Disease, Prognosis, Quantitative © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Qing Fu
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Samer Alabed
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Stephen P. Hoole
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - George Abraham
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Jonathan R. Weir-McCall
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
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Patel AR, Kramer CM. Perfusion Imaging for the Heart. Magn Reson Imaging Clin N Am 2024; 32:125-134. [PMID: 38007275 DOI: 10.1016/j.mric.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
The use of myocardial perfusion imaging during a stress cardiac magnetic resonance (CMR) examination for the evaluation of coronary artery disease is now recommended by both US and European guidelines. Several studies have demonstrated high diagnostic accuracy for the detection of hemodynamically significant coronary artery disease. Stress perfusion CMR has been shown to be a noninvasive and cost-effective alternative to guide coronary revascularization.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA.
| | - Christopher M Kramer
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA
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Gerber BL. Review and critical appraisal of the indications for cardiac magnetic resonance imaging in the ESC guidelines. Acta Cardiol 2024; 79:5-19. [PMID: 37962294 DOI: 10.1080/00015385.2023.2279417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Cardiac MRI has made significant advances in the past decade, becoming an important technique for the evaluation of various cardiac pathologies. The aim of this document is to review the current indications for performing cardiac MRI based on the current ESC guidelines for STEMI, NSTEMI, chronic coronary artery disease, heart failure, arrhythmias, sudden cardiac death, valvular heart disease, pericardial disease and congenital heart disease. The review discusses the diagnostic and prognostic value of cMR for numerous cardiac diseases, and its important value in assessing structural heart disease and predicting arrhythmia risk. Additionally, it reflects upon the appropriateness of the guidelines and points out areas where the indications should be revised in future editions, based on the author's personal opinion. It is suggested that guideline criteria for the use of cMR should be more explicit to promote its use and lead to more specific reimbursements. However, further studies are needed to even better document the value of cMR in the future.
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Affiliation(s)
- Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc Woluwe St. Lambert, Belgium
- CARD Unit, Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
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Pezel T, Unterseeh T, Garot P, Hovasse T, Sanguineti F, Toupin S, Morisset S, Champagne S, Garot J. Long-Term Prognostic Value of Stress Cardiovascular Magnetic Resonance-Related Coronary Revascularization to Predict Death: A Large Registry With >200 000 Patient-Years of Follow-Up. Circ Cardiovasc Imaging 2021; 14:e012789. [PMID: 34612046 DOI: 10.1161/circimaging.121.012789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the benefit of coronary revascularization in patients with stable coronary disease is debated, data assessing the potential interest of stress cardiovascular magnetic resonance (CMR) to guide coronary revascularization are limited. We aimed to assess the long-term prognostic value of stress CMR-related coronary revascularization in consecutive patients from a large registry. METHODS Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range, 5.0-8.0) included all consecutive patients referred for stress CMR. CMR-related coronary revascularization was defined by any coronary revascularization performed within 90 days after CMR. The primary outcome was all-cause death based on the National Death Registry. RESULTS Among the 31 762 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2679 (8.4%) died at 206 453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement by CMR were associated with death (both P<0.001). In multivariable Cox regression, inducible ischemia and late gadolinium enhancement were independent predictors of death (hazard ratio, 1.61 [99.5% CI, 1.41-1.84]; hazard ratio, 1.62 [99.5% CI, 1.41-1.86], respectively; P<0.001). In the overall population, CMR-related coronary revascularization was an independent predictor of greater survival (hazard ratio, 0.58 [99.5% CI, 0.46-0.74]; P<0.001). In 1680, 1:1 matched patients using a limited number of variables (840 revascularized, 840 nonrevascularized), CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (≥6 segments, P<0.001) but showed no benefit in patients with mild or moderate ischemia (<6 segments, P=0.109). Using multivariable analysis in the propensity-matched population, CMR-related revascularization remained an independent predictor of a lower incidence of all-cause mortality (hazard ratio, 0.66 [99.5% CI, 0.54-0.80], P<0.001). CONCLUSIONS In this large observational series of consecutive patients, stress perfusion CMR had important incremental long-term prognostic value to predict death over traditional risk factors. CMR-related revascularization was associated with a lower incidence of death in patients with severe ischemia.
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Affiliation(s)
- Théo Pezel
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.).,Division of Cardiology, Johns Hopkins University, Baltimore, MD (T.P.)
| | - Thierry Unterseeh
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Thomas Hovasse
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Francesca Sanguineti
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Solenn Toupin
- Siemens Healthcare France, Saint-Denis, France (S.T.)
| | | | - Stéphane Champagne
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
| | - Jérôme Garot
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.)
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