CAD: Chronic Coronary Syndromes
Satoshi Nakamura, MD, PhD
Doctor
Mie University Hospital
Tsu, Mie, Japan
Satoshi Nakamura, MD, PhD
Doctor
Mie University Hospital
Tsu, Mie, Japan
Masaki Ishida, MD
Associate professor
Mie University Hospital
Tsu, Mie, Japan
Kei Nakata, MD
Clinical fellow
Mie University Hospital
Tsu, Mie, Japan
Masafumi Takafuji, MD, PhD
Assistant Professor
Mie University Hospital
Tsu, Mie, Japan
Shiro Nakamori, MD
Senior Lecturer
Mie University Hospital
Tsu, Mie, Japan
Tairo Kurita, MD
Senior Lecturer
Mie University Hospital
Tsu, Mie, Japan
Haruno Ito, MD
Clinical fellow
Mie University Hospital
Tsu, Mie, Japan
Kaoru Dohi, MD, PhD
Professor
Mie University Hospital
Tsu, Mie, Japan
Hajime Sakuma, MD, PhD
Professor
Mie University Hospital
Tsu, Mie, Japan
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 circulation1,2. 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.
Methods:
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.
Results:
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) (Figure 1), and prognoses were comparable between the subgroup with ischemia and no reduced CFR and the subgroup with no ischemia and reduced 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).
Conclusion:
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 reduced global CFR may play a role as important as that of ischemia due to epicardial coronary stenosis in the risk stratification of CAD patients.