SCMR 22nd Annual Scientific Sessions
Malte Kelm, MD
Head of Department
Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Medical Faculty, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Heinrich Heine University Düsseldorf, Medical Faculty, Germany
Cardiovascular magnetic resonance (CMR) derived perfusion imaging holds a class Ia recommendation to detect and stratify coronary artery disease (CAD) non-invasively. Commonly, hyperemia is induced by an intravenous infusion of adenosine in a body weight adapted dosage. However, efficacy of adenosine to induce maximal hyperemia via peripheral line is imperfect and additional adenosine specific effects exclude indicated patients having comorbidities (e.g. obstructive lung disease, AV-bocks). Luckily, the selective A2A-receptor activator regadenoson has the main advantages of being easier to handle (bolus application) and to be not restricted to patients without certain comorbidities. However, there is only few data on the prognostic value of regadenoson perfusion CMR to predict clinical endpoints. To test the predictive value of regadenoson perfusion CMR, our hypothesis was, that a “negative” ischemia test result by regadenoson-CMR predicted freedom from MACE at 12 month better than standard risk prediction models.
From May 2015 till December 2016, 679 patients, with known or suspected CAD with intermediate risk were retrospectively analyzed. Cardiovascular risk factors (CVRF) like age, sex, arterial hypertension, dis-/hyperlipidemia, cigarette smoking status and diabetes were recorded. All patients received perfusion CMR (Philips 1.5 Tesla) with regadenoson (0.4 mg) and a positive ischemia test was defined as perfusion defects in ≥ 1,5 cardiac segments (using the 17-segment model). Major adverse cardiovascular events (MACE) were defined as cardiovascular death, rehospitalisation due to myocardial infarction and rehospitalisation due to revascularization. Follow up was 12 month.
Of all patients analyzed, 70,9 % (n=482) showed negative ischemia testing in CMR and were thus followed up for 12 month. From these patients, 251 (52 %) had a pre-existing coronary artery disease. The study population had a mean age 67 years (66 % male and 44% female) with 2,75 ± 1,37 CVRF. The Framingham risk prediction models predicted a 12-month MACE rate of 9,3 +/- 1,2% in our collective. Regadenoson was well tolerated and no side effects were reported. The primary endpoint (MACE) occurred in 18 patients (3,7%). Of these patients, 4 (0,8 %) died due to cardiovascular events, 6 (1,2 %) suffered from a myocardial infarction and 8 (1,6 %) received coronary revascularization. Thus, an event-free survival was correctly predicted in 96.3 % of all patients, which is superior to the Framingham prediction model and non-inferior to predictive values of adenosine perfusion CMR.
A negative regadenoson-perfusion CMR is superior in prediction of event free survival compared to standard risk prediction models and non-inferior to adenosine-perfusion CMR risk prediction.