Prognostic value of a new semiquantitative score system for adenosine stress myocardial perfusion by CMR
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.
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.
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).
The score of ischemic burden proposed herein has prognostic value. Persistence of a perfusion defect has the strongest impact on prognosis.
• 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.
KeywordsMyocardium Perfusion Adenosine Prognosis
Coronary artery disease
Cardiovascular magnetic resonance
Fractional flow reserve
Ischemic heart disease
Positron emission tomography
Receiver operating characteristic
Score of ischemic burden
Wall motility alteration
The authors state that this work has not received any funding.
Compliance with ethical standards
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.
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.
• Performed at one institution
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