Women's Heart Disease

1350777 - Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Analysis of the multicenter SPINS Retrospective Registry

Thursday, January 26, 2023

2:50 PM – 3:00 PM

Location: Sandpiper

Presenting Author(s)

SI

Sabeeh Islam, MBBS

Research Fellow
Brigham and Women's Hospital, United States

Primary Author(s)

Bobby Heydari, MD

Associate Professor
University of Calgary
Calgary, Alberta, Canada

Co-Author(s)

Yin Ge, MD

Cardiologist
University of Toronto
Cambridge, Massachusetts, Canada
PA

Panagiotis Antiochos, MD

Cardiologist
University Hospital of Lausanne (CHUV), Switzerland
Kevin Steel, MD

Cardiologist
St Joseph Medical Center
Bellingham, Washington, United States
SB

Scott E. Bingham, MD

Cardiologist
Revere Health
Provo, Utah, United States
SA

Shuaib Abdullah, MD

Cardiologist
VA North Texas Medical Center and University of Texas-Southwestern Medical School, United States
JM

J. Ronald Mikolich, MD

Professor
Northeast Ohio Medical University
Sharon, Pennsylvania, United States
Andrew E. E. Arai, MD

Cardiologist
NIH
Kensington, Maryland, United States
WB

W. Patricia Bandettini, MD

Cardiologist
NIH, Maryland, United States
Amit R. Patel, MD

Professor
University of Virginia Health System
Charlottesville, Virginia, United States
Sujata Shanbhag, MD

Cardiologist
NIH
Bethesda, Maryland, United States
AF

Afshin Farzaneh-Far, MD

Cardiologist
University of Illinois
Chicago, Illinois, United States
John F. Heitner, MD

Cardiologist
New York University Grossman School of Medicine
Brooklyn, New York, United States
Chetan Shenoy, MBBS, MS

Associate Professor of Medicine
University of Minnesota
Minneapolis, Minnesota, United States
Steve W. Leung, MD, FSCMR

Associate Professor
University of Kentucky
Lexington, Kentucky, United States
Jorge A. Gonzalez, MD

Cardiologist
Scripps Clinic Medical Group
La Jolla, California, United States
Subha Raman, MD

Professor
IU Health/IU School of Medicine
Indianapolis, Indiana, United States
Victor A. Ferrari, MD

Chair, Penn Cardiovascular Imaging Council
Hospital of the University of Pennsylvania and Penn Cardiovascular Institute
Phila., Pennsylvania, United States
Dipan J. Shah, MD

Chief, Division of Cardiovascular Imaging
Houston Methodist DeBakey Heart & Vascular Center
Houston, Texas, United States
Jeanette Schulz-Menger, MD

Professor
Charité – Universitätsmedizin Berlin, ECRC, MDC, Helios Klinikum Berlin Buch, DZHK, Berlin, Germany
Berlin, Berlin, Germany
Matthias Stuber, PhD

Professor
University Hospital (CHUV) and University of Lausanne (UNIL)
Lausanne, Switzerland
Orlando P. Simonetti, PhD

Professor, Medicine and Radiology
The Ohio State University
Columbus, Ohio, United States
Raymond Y. Kwong, MD, MPH, FSCMR

Director of Cardiac Magnetic Resonance Imaging
Brigham and Women's Hospital
Boston, Massachusetts, United States

Disclosure(s):

Andrew E. E. Arai, MD: No relevant disclosure to display

Steve W. Leung, MD, FSCMR: No relevant disclosure to display

Jorge A. Gonzalez, MD: No financial relationships to disclose

Subha Raman, MD: No financial relationships to disclose

Victor A. Ferrari, MD: No financial relationships to disclose

Dipan J. Shah, MD: No relevant disclosure to display

Jeanette Schulz-Menger, MD: No relevant disclosure to display

Orlando P. Simonetti, PhD: No relevant disclosure to display

Background:

Cardiovascular disease remains the leading cause of mortality in women while current non-invasive cardiac imaging techniques have sex-specific limitations. We sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization/costs of stress perfusion cardiac magnetic resonance imaging (CMR) for suspected cardiovascular disease.

Methods:

Sex specific prognostic performance was evaluated in 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States) registry. Primary outcome measure was a composite of cardiovascular death and non-fatal myocardial infarction; secondary added hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting (CABG).

Results:

SPINS included 1,104 women (47% cohort); women had higher prevalence of chest pain (62% vs 50%, P< 0.0001) but lower use of medical therapies. At 5.4-year median follow-up, women with normal stress CMR had similar low annualized rate of primary composite outcome as men (0.54%/yr vs 0.75%/yr, P=NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/year vs 0.54%) and secondary (9.8%/year vs 1.6%/year) composite outcomes (P < 0.0001 for both) compared to women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR 2.64, 95% CI 1.20-5.90, P=0.02) and secondary (HR 2.09, 95% CI 1.43-3.08, P< 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary revascularization (3.6% versus 7.3%, P=0.0001) and downstream costs ($114 vs $171, P=0.001) at 90-days following CMR. There was no effect of sex on image quality.

Conclusion: Stress CMR demonstrated excellent prognostic performance with lower rates of invasive revascularization referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women.