Long-term prognostic value of whole-heart coronary magnetic resonance angiography

Abstract

Background Coronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the usefulness of CMRA for risk stratification in short-term follow-up, the long-term prognostic value of CMRA remains unclear. The purpose of this study was to evaluate the long-term prognostic value of CMRA. Methods A total of 506 patients without history of myocardial infarction or prior coronary artery revascularization underwent free-breathing whole-heart CMRA between 2009 and 2015. Images were acquired using a 1.5 T or 3 T scanner and visually evaluated as the consensus decisions of two observers. Obstructive CAD on CMRA was defined as luminal narrowing of ≥ 50% in at least one coronary artery. Major adverse cardiac events (MACE) comprised cardiac death, nonfatal myocardial infarction, and unstable angina. Results Obstructive CAD on CMRA was observed in 214 patients (42%). During follow-up (median, 5.6 years), 31 MACE occurred. Kaplan–Meier curve analysis revealed a significant difference in event-free survival between patients with and without obstructive CAD for MACE (log-rank, p = 0.003) and cardiac death (p = 0.012). Annualized event rates for MACE in patients with no obstructive CAD, 1-vessel disease, 2-vessel disease, and left-main or 3-vessel disease were 0.6%, 1.5%, 2.3%, and 3.6%, respectively (log-rank, p = 0.003). Cox proportional hazard regression analysis showed that, among obstructive CAD on CMRA and clinical risk factors (age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of CAD), obstructive CAD and diabetes were significant predictors of MACE (hazard ratios, 2.9 [p = 0.005] and 2.2 [p = 0.034], respectively). In multivariate analysis, obstructive CAD remained an independent predictor (adjusted hazard ratio, 2.6 [p = 0.010]) after adjusting for diabetes. Addition of obstructive CAD to clinical risk factors significantly increased the global chi-square result from 8.3 to 13.8 (p = 0.022). Conclusions In long-term follow-up, free breathing whole heart CMRA allows non-invasive risk stratification for MACE and cardiac death and provides incremental prognostic value over conventional risk factors in patients without a history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA were associated with worse prognosis. Importantly, patients without obstructive CAD on CMRA displayed favorable prognosis.

High-resolution non-contrast free-breathing coronary cardiovascular magnetic resonance angiography for detection of coronary artery disease: validation against invasive coronary angiography

“…One recent study used compressed sensing to accelerate image acquisition within a rapid timeframe, although in that study, contrast administration was required [ 22 ], and did not compare to the invasive reference standard of ICA as we did in this study. More recently, obstructive CAD seen on CCMRA was found to provide incremental prognostic value over traditional risk factors [ 23 ]. One important step to clinical translation in our study is the ability to achieve 100% respiratory scan efficiency and high-resolution imaging with predictable scan times (thus not dependent on the specific subject’s breathing pattern).…”

Sparse 3D contrast-enhanced whole-heart imaging for coronary artery evaluation

“…Another early study conducted by Sakuma et al, with 131 patients using the SSFP whole-heart CMRA approach, demonstrated moderate sensitivity and high specificity for the detection of significant narrowing in coronary segments of ≥ 2 mm in diameter [9]. A recent wholeheart CMRA study by Nakamura et al showed the potential of this sequence in the noninvasive risk stratification of patients for major adverse cardiovascular [10].…”

“…showed the potential of this sequence in the noninvasive risk stratification of patients for major adverse cardiovascular events and cardiac death, while providing incremental prognostic value over conventional risk factors in those without history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA was associated with worse prognosis [ 10 ].…”

Technical Advancements in Abdominal Diffusion-weighted Imaging

“…For these reasons, ssh-EPI has been highly successful in abdominal DWI as well as brain DWI. [40][41][42][43][44] However, EPI, especially ssh-EPI, has the disadvantage of being susceptible to chemical shift and, similarly, the off-Technical Advancements in Abdominal DWI Epub ahead of print resonance effect resulting from variations in local magnetic susceptibility. The corresponding artifacts are called chemical shift and susceptibility artifacts, respectively.…”