Prognostic utility of cardiovascular magnetic resonance upright maximal treadmill exercise testing

Abstract

BackgroundLeft ventricular wall motion abnormalities (LVWMA) observed during cardiovascular magnetic resonance (CMR) pharmacologic stress testing can be used to determine cardiac prognosis, but currently, information regarding the prognostic utility of upright maximal treadmill induced LVWMA is unknown. Our objective was to determine the prognostic utility of upright maximal treadmill exercise stress CMR.MethodsOne hundred and fifteen (115) men and women with known or suspected coronary arteriosclerosis and an appropriate indication for cardiovascular (CV) imaging to supplement ST segment stress testing underwent an upright treadmill exercise CMR stress test in which LVWMA were identified before and immediately after exercise. Personnel blinded to results determined the post-test incidence of cardiac events (cardiac death, myocardial infarctions [MI], and unstable angina warranting hospital admission or coronary arterial revascularization).ResultsAll participants completed the testing protocol, with 90 % completing image acquisition within 60 s of exercise cessation. MI or cardiac death occurred in 3 % of individuals without and 17 % of individuals with inducible LVWMA (p = 0.024). The combination of MI, cardiac death, and unstable angina warranting hospitalization occurred in 14 % of individuals without and 47 % of individuals with inducible LVWMA (p = 0.002). The addition of CMR imaging identified those at risk for future events (p = 0.002), as opposed to the electrocardiogram stress test alone (p = 0.63).ConclusionsIn patients with or suspected of coronary arteriosclerosis and appropriate indication for imaging to supplement ST segment analysis during upright treadmill exercise, the presence of inducible LVWMA during treadmill exercise stress CMR supplements ST segment monitoring and helps identify those at risk of the future combined endpoints of myocardial infarction, cardiac death, and unstable angina warranting hospitalization.

Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques

“…CMR is limited in this respect due to the need for supine scanning and consistent positioning within the scanner. Recent studies however have assessed the feasibility of exercise stress CMR and showed comparable accuracy to echocardiography, though it has yet to reach mainstream clinical use[ 62 , 63 ]. Promising developments are “steppers” and cycle ergometers that can attach directly to the MRI scanner, and thereby eliminate the need to transfer the patient from the exercise equipment into the scanner[ 64 , 65 ].…”

Noninvasive Imaging to Evaluate Women With Stable Ischemic Heart Disease

“…A recent study evaluated 115 subjects (38% women) with treadmill exercise stress CMR and found that the presence of inducible regional wall motion abnormalities identified those at risk of future IHD events (99). …”

Review of Journal of Cardiovascular Magnetic Resonance 2015

“…One hundred and fifteen (115) men and women with known or suspected coronary arteriosclerosis underwent an upright treadmill exercise CMR stress test in which left ventricular wall motion abnormalities (LVWMA) were identified before and immediately after exercise [111]. All participants completed the testing protocol, with 90 % completing image acquisition within 60 s of exercise cessation.…”