Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry
Affiliation:
1. Stephenson Cardiac Imaging Center, University of Calgary, Calgary, Alberta, Canada;2. Division of Cardiology, St Michael‘s Hospital, University of Toronto, Toronto, Ontario, Canada;3. Cardiology Division, University Hospital of Lausanne (CHUV), Lausanne, Switzerland;4. Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA;5. St Joseph Medical Center, Bellingham, Washington, USA;6. Revere Health, Provo, Utah, USA;7. VA North Texas Medical Center and University of Texas—Southwestern Medical School, Dallas, Texas, USA;8. Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA;9. Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA;10. Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA;11. Cardiology Division, University of Illinois, Chicago, Illinois, USA;12. Cardiovascular Division, New York University Grossman School of Medicine, New York, New York, USA;13. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA;14. Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA;15. Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA;p. Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, Indiana, USA;q. Hospital of the University of Pennsylvania and Penn Cardiovascular Institute, Philadelphia, Pennsylvania, USA;r. Weill Cornell Medical College, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA;s. Charité, Medical Faculty of the Humboldt University, Experimental and Clinical Research Center, Berlin, Germany;t. Helios Clinics, Cardiology, Berlin, Germany;u. Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland;v. Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
Abstract:
BackgroundCardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations.ObjectivesIn this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD.MethodsSex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) Registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting.ResultsSPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality.ConclusionsStress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891)
