Prognostic value of negative stress cardiac magnetic resonance imaging in patients with moderate-severe coronary artery stenosis

Ailís Ceara Haney; Janek Salatzki; Hauke Hund; Matthias G Friedrich; Evangelos Giannitsis; Norbert Frey; Henning Steen; Dirk Loßnitzer; Johannes Riffel; Florian André

doi:10.3389/fcvm.2023.1264374

Prognostic value of negative stress cardiac magnetic resonance imaging in patients with moderate-severe coronary artery stenosis

Front Cardiovasc Med. 2023 Oct 6:10:1264374. doi: 10.3389/fcvm.2023.1264374. eCollection 2023.

Authors

Ailís Ceara Haney^#¹, Janek Salatzki^#^{1

2}, Hauke Hund^{1

3}, Matthias G Friedrich^{1

4}, Evangelos Giannitsis^{1

2}, Norbert Frey^{1

2}, Henning Steen^{1

2}, Dirk Loßnitzer^{1

5

6}, Johannes Riffel^#^{1

7}, Florian André^#^{1

2}

Affiliations

¹ Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
² German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
³ GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany.
⁴ Division of Cardiology, Departments of Medicine and Diagnostic Radiology, Mc-Gill University Health Centre, Montreal, QC, Canada.
⁵ First Department of Medicine-Cardiology, University Medical Centre Mannheim Mannheim, Germany.
⁶ German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
⁷ Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany.

^# Contributed equally.

Abstract

Objective: This study aims to evaluate the prognostic value of stress cardiac magnetic resonance (CMR) without inducible ischemia in a real-world cohort of patients with known severe coronary artery stenosis.

Background: The prognosis of patients with severe coronary artery stenosis and without inducible ischemia using stress CMR remains uncertain, even though its identification of functionally significant coronary artery disease (CAD) is excellent.

Materials and methods: Patients without inducible ischemia and known CAD who underwent stress CMR between February 2015 and December 2016 were included in this retrospective study. These patients were divided into two groups: group 1 with stenosis of 50%-75% and group 2 with stenosis of >75%. The primary endpoint was defined as the occurrence of a major adverse cardiovascular event (MACE) [cardiac death, non-fatal myocardial infarction (MI), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG)].

Results: Real-world data collected from 169 patients with a median age of 69 (60-75) years were included. The median follow-up was 5.5 (IQR 4.1-6.6) years. Events occurred after a mean time of 3.0 ± 2.2 years in group 1 and 3.7 ± 2.0 years in group 2 (p = 0.35). Sixteen (18.8%) patients in group 1 and 23 (27.4%) patients in group 2 suffered from MACE without a significant difference between the two groups (p = 0.33). In group 2, one cardiac death (1.2%), seven non-fatal MI (8.3%), 15 PCI (17.9%), and one CABG (1.2%) occurred.

Conclusion: The findings of this pilot study suggest that long-term outcomes in a real-world patient cohort with known severe and moderate coronary artery stenosis but without inducible ischemia were similar. Stress CMR may provide valuable risk stratification in patients with angiographically significant but hemodynamically non-obstructive coronary lesions.

Keywords: cardiovascular imaging; coronary artery disease; ischemia; outcome; stress cardiac magnetic resonance tomography.

Grants and funding

JS was funded by the German Centre for Cardiovascular Research (DZHK—Deutsches Zentrum für Herz-Kreislauf-Forschung). For the publication fee we acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding programme “Open Access Publikationskosten” as well as by Heidelberg University.