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Published on: February 16, 2016
Ischemic burden and clinical outcome: is one 'culprit' ischemic segment by dobutamine stress magnetic resonance
Sorin Giusca1, Sebastian Kelle2, Eike Nagel3
1University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Insights
Even one segment of inducible ischemia detected by dobutamine stress cardiac magnetic resonance imaging (DCMR) predicts hard cardiac events in patients with coronary artery disease (CAD). This finding highlights the prognostic value of DCMR in assessing cardiac risk.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Diagnostic Tools
Background:
- Coronary artery disease (CAD) poses a significant risk for major adverse cardiac events.
- Dobutamine stress cardiac magnetic resonance imaging (DCMR) is a key diagnostic tool for evaluating myocardial ischemia.
- Predicting hard cardiac events (cardiac death, nonfatal myocardial infarction) is crucial for patient management.
Purpose of the Study:
- To assess the predictive value of ischemic burden, quantified by the number of ischemic segments on DCMR, for hard cardiac events.
- To determine if even minimal inducible ischemia impacts long-term cardiac outcomes in patients with known or suspected CAD.
- To evaluate the prognostic significance of DCMR findings in a large patient cohort.
Main Methods:
- A retrospective analysis of 3166 patients undergoing DCMR for known or suspected CAD.
- Patients were categorized into groups based on the number of ischemic segments (0, 1, 2, or ≥3).
- Hard cardiac events (cardiac death, nonfatal MI) were tracked; patients with early revascularization were excluded from survival analysis.
Main Results:
- Over a median follow-up of 3.1 years, 5.9% of patients experienced hard cardiac events.
- Patients with one ischemic segment had a significantly higher annual event rate (~6%) compared to those without ischemia (0.6%).
- The event rate in patients with one ischemic segment was comparable to those with two or ≥3 ischemic segments.
Conclusions:
- Inducible ischemia in a single myocardial segment on DCMR is a significant predictor of hard cardiac events.
- DCMR effectively identifies patients at elevated risk for adverse cardiac outcomes, even with limited ischemia.
- These findings underscore the importance of detecting even focal ischemia for risk stratification in CAD patients.
Aims:
We sought to evaluate the impact of ischemic burden for the prediction of hard cardiac events (cardiac death or nonfatal myocardial infarction) in patients with known or suspected CAD who undergo dobutamine stress cardiac magnetic resonance imaging (DCMR).
Methods:
We included 3166 patients (pts.), mean age 63 ± 12 years, 27% female, who underwent DCMR in 3 tertiary cardiac centres (University Hospital Heildelberg, German Heart Institute and Kings College London). Pts. were separated in groups based on the number of ischemic segments by wall motion abnormalities (WMA) as follows: 1. no ischemic segment, 2. one ischemic segment, 3. two ischemic segments and 4. ≥ three ischemic segments. Cardiac death and nonfatal myocardial infarction were registered as hard cardiac events. Pts. with an "early" revascularization procedure (in the first three months after DCMR) were not included in the final survival analysis.
Results:
Pts. were followed for a median of 3.1 years (iqr 2-4.5 years). 187 (5.9%) pts. experienced hard cardiac events. 2349 (74.2%) had no inducible ischemia, 189 (6%) had ischemia in 1 segment, 292 (9.2%) in 2 segments and 336 (10.6%) ≥ 3 segments. Patients with only 1 ischemic segment showed a high rate of hard cardiac events of ∼ 6% annually, which was 10-fold higher compared to those without ischemia (0.6% annually, p < 0.001) but similar to those with 2 and ≥ 3 ischemic segments (∼ 5.5% and ∼ 7%, p = NS).
Conclusions:
The presence of inducible ischemia even in a single 'culprit' myocardial segment during DCMR is enough to predict hard cardiac events in patients with known or suspected CAD.
