Long-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance |
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Authors: | Wenli Zhou Jonan Chun Yin Lee Siu Ting Leung Alta Lai Tang-Fei Lee Jeanie Betsy Chiang Yuet Wong Cheng Hiu-Lam Chan Kai-Hang Yiu Victor King-Man Goh Dudley John Pennell Ming-Yen Ng |
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Affiliation: | 1. Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong;2. Department of Radiology & Imaging, Queen Elizabeth Hospital, Hong Kong;3. Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong;4. Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong;5. Division of Cardiology, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong;6. Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong;7. Hong Kong Sanatorium and Hospital, Hong Kong;8. School of Public Health, The Chinese University of Hong Kong, Hong Kong;9. Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom;10. National Heart and Lung Institute, Imperial College, London, United Kingdom;11. Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China |
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Abstract: | ObjectivesThis study investigated the prognosis of coronary microvascular disease (CMD) as determined by stress perfusion cardiac magnetic resonance (CMR) in patients with ischemic symptoms but without significant coronary artery disease (CAD).BackgroundPatients with CMD have poorer prognosis with various cardiac diseases. The myocardial perfusion reserve index (MPRI) derived from noninvasive stress perfusion CMR has been established to diagnose microvascular angina with a threshold MPRI <1.4. The prognosis of CMD as determined by MPRI is unknown.MethodsChest pain patients without epicardial CAD or myocardial disease from January 2009 to December 2017 were retrospectively included from 3 imaging centers in Hong Kong (HK). Stress perfusion CMR examinations were performed using either adenosine or adenosine triphosphate. Adequate stress was assessed by achieving splenic switch-off sign. Measurement of MPRI was performed in all stress perfusion CMR scans. Patients were followed for major adverse cardiovascular events defined as all-cause death, acute coronary syndrome (ACS), epicardial CAD development, heart failure hospitalization and non-fatal stroke.ResultsA total of 218 patients were studied (mean age 59 ± 12 years; 49.5% male) and the average MPRI of that cohort was 1.56 ± 0.33. Females and a history of hyperlipidemia were predictors of lower MPRI. Major adverse cardiovascular events (MACE) occurred in 15.6% of patients during a median follow-up of 5.5 years (interquartile range: 4.6 to 6.8 years). The optimal cutoff value of MPRI in predicting MACE was found with a threshold MPRI ≤1.47. Patients with MPRI ≤1.47 had three-fold increased risk of MACE compared with those with MPRI >1.47 (hazard ratio [HR]: 3.14; 95% confidence interval [CI]: 1.58 to 6.25; p = 0.001). Multivariate Cox regression after adjusting for age and hypertension demonstrated that MPRI was an independent predictor of MACE (HR: 0.10; 95% CI: 0.03 to 0.34; p < 0.001).ConclusionsStress perfusion CMR-derived MPRI is an independent imaging marker that predicts MACE in patients with ischemic symptom and no overt CAD over the medium term. |
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Keywords: | coronary microvascular disease MPRI prognosis stress CMR ACS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" acute coronary syndrome CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease CCTA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" coronary computed tomography angiography CMD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" coronary microvascular disease CMR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" cardiac magnetic resonance ICA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" invasive coronary angiography MACE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" major adverse cardiovascular event(s) MPRI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" myocardial perfusion reserve index |
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