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

Bobak Heydari1, Yin Ge2, Panagiotis Antiochos3

  • 1Stephenson Cardiac Imaging Center, University of Calgary, Calgary, Alberta, Canada.

JACC. Cardiovascular Imaging
|February 10, 2023
PubMed

Insights

Stress cardiac magnetic resonance (CMR) imaging effectively predicts cardiovascular events in women, similar to men. This noninvasive tool shows excellent prognostic performance and should be considered for initial evaluation in women.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiovascular Disease Research

Background:

  • Cardiovascular disease (CVD) is the leading cause of death in women.
  • Existing noninvasive cardiac imaging methods have limitations specific to sex.
  • The prognostic utility of stress perfusion cardiac magnetic resonance (CMR) in women requires further investigation.

Purpose of the Study:

  • To assess the effect of sex on the prognostic value of stress perfusion CMR.
  • To evaluate sex-specific differences in downstream invasive revascularization and costs.
  • To determine the role of stress CMR in suspected CVD in women.

Main Methods:

  • A multicenter registry (SPINS Study) of 2,349 patients with suspected CVD.
  • Evaluation of sex-specific prognostic performance using stress perfusion CMR.
  • Primary outcome: composite of cardiovascular death and nonfatal myocardial infarction.
  • Secondary outcomes: hospitalization for unstable angina/heart failure, late unplanned coronary artery bypass grafting.

Main Results:

  • Women (47%) had higher chest pain prevalence but lower medical therapy use.
  • Normal stress CMR showed similar low event rates in women and men (0.54%/y vs 0.75%/y).
  • Abnormal stress CMR identified higher risk in women (primary: 3.74%/y, secondary: 9.8%/y).
  • Abnormal CMR was an independent predictor of outcomes in women (HR: 2.64, P=0.02; HR: 2.09, P<0.0001).
  • No sex-based effect modification was observed.
  • Women had lower rates of invasive angiography (3.6% vs 7.3%) and costs ($114 vs $171) post-CMR.

Conclusions:

  • Stress CMR offers excellent prognostic performance for women with suspected CVD.
  • Abnormal findings on stress CMR independently predict adverse cardiovascular events in women.
  • Stress CMR should be considered a first-line noninvasive imaging tool for evaluating women.
  • Lower rates of invasive procedures and costs were observed in women post-stress CMR.
Abstract

Keywords:
cost-effectivenessischemic heart diseaseprognosisstress CMRwomen

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