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European Radiology

, Volume 29, Issue 5, pp 2263–2271 | Cite as

Prognostic value of a new semiquantitative score system for adenosine stress myocardial perfusion by CMR

  • Sonia Gómez-RevellesEmail author
  • Xavier Rossello
  • José Díaz-Villanueva
  • Ignacio López-Lima
  • Esteban Sciarresi
  • Mariano Estofán
  • Francesc Carreras
  • Sandra Pujadas
  • Guillem Pons-Lladó
Magnetic Resonance

Abstract

Objectives

Cardiovascular magnetic resonance (CMR) provides information on myocardial ischemia through stress perfusion studies. In clinical practice, the grading of induced perfusion defects is performed by visual estimation of their extension. The aim of our study is to devise a score of the degree of ischemia and to test its prognostic value.

Methods

Between 2009 and 2011, patients with diagnosed or suspected coronary artery disease underwent stress perfusion CMR. A score of ischemic burden was calculated on the basis of (1) stress-induced perfusion defect, (2) persistence, (3) transmurality, and (4) stress-induced contractile defect. Follow-up was censored after 4 years and primary end-point was defined by a composite of death, heart failure episode, acute coronary syndrome, and ventricular arrhythmias. Univariate and multivariate logistic regressions were used to assess the strength of the association between the CMR ischemic variables, and the composite outcome.

Results

Forty-four of the 128 patients (34%) presented with adverse events, while 84 (66%) did not. Sixty-one patients (48%) had negative perfusion studies while 67 (52%) showed perfusion defect. Patients with positive perfusion studies and adverse events (n = 39) had higher number of segments with persistent defect (3.3 vs 1.3, p = 0.001) and highest score (19.6 vs 13.3 p = 0.012) than patients with positive perfusion studies and absence of events (n = 28). The number of segments with persistent defect showed the strongest predictive value of adverse events (OR 1.54; CI 1.19–2.00; p < 0.001).

Conclusions

The score of ischemic burden proposed herein has prognostic value. Persistence of a perfusion defect has the strongest impact on prognosis.

Key Points

• Cardiovascular magnetic resonance provides information on myocardial ischemia by visual estimation of the presence of perfusion defects induced by stress.

• There is not a standardized method for grading perfusion defects which, in practice, is performed by visual estimation of their extension.

• As proven in this study, the integration of several parameters of perfusion defects (in addition to extension) into a semiquantitative score has prognostic value.

Keywords

Myocardium Perfusion Adenosine Prognosis 

Abbreviations

CAD

Coronary artery disease

CMR

Cardiovascular magnetic resonance

CV

Cardiovascular

FFR

Fractional flow reserve

IHD

Ischemic heart disease

IQR

Interquartile range

LV

Left ventricular

MR

Magnetic resonance

PET

Positron emission tomography

ROC

Receiver operating characteristic

SD

Standard deviation

SIB

Score of ischemic burden

WMA

Wall motility alteration

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Guillem Pons-Lladó, MD, PhD.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent ethical approval

Written informed consent was not required because our study was designed as a descriptive one with retrospective collection of CMR and follow-up data which were available on the clinical recordings of the center. As such, no therapeutic measures were undertaken on the basis of the data review nor any additional medical visit was elicited as a result of the analyses.

Ethical approval

Institutional Review Board approval was not required because our study was designed as a descriptive one with retrospective collection of CMR and follow-up data which were available on the clinical recordings of the center. As such, no therapeutic measures were undertaken on the basis of the data review nor any additional medical visit was elicited as a result of the analyses.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Sonia Gómez-Revelles
    • 1
    • 2
    • 3
    Email author
  • Xavier Rossello
    • 1
  • José Díaz-Villanueva
    • 3
  • Ignacio López-Lima
    • 3
  • Esteban Sciarresi
    • 3
  • Mariano Estofán
    • 3
  • Francesc Carreras
    • 1
    • 2
    • 3
  • Sandra Pujadas
    • 1
    • 2
  • Guillem Pons-Lladó
    • 1
    • 2
    • 3
  1. 1.Cardiac Imaging Unit, Cardiology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
  2. 2.Clínica Creu BlancaBarcelonaSpain
  3. 3.Universitat Autònoma de BarcelonaBarcelonaSpain

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