4 - Stress Cardiac Magnetic Resonance Provides Effective Reclassification In Patients with Suspected Coronary Artery Disease: Results from the multicenter SCMR Stress CMR Imaging in the US (SPINS) Study

Friday, February 14, 2020

8:36 AM – 8:48 AM

Location: Canary 3 & 4

Background: We investigated the ability of stress cardiac magnetic resonance imaging (CMR) to provide risk reclassification in patients with suspected stable coronary artery disease (CAD) in a multicentre setting across the United States.

Methods: Using data from 13 sites, a cohort of 2349 consecutive patients (63±11 years, 53% male) presenting with chest pain and referred for stress CMR was followed for a median of 5.4 years. The primary outcome (MACE) was defined as cardiovascular (CV) death or myocardial infarction (MI). The prognostic association of presence of ischemia with MACE was evaluated and the extent of net reclassification improvement (NRI) by CMR across guideline-based risk categories (low < 1%, intermediate 1%-3%, and high >3%) was determined.

Results: One hundred fifty three MACE occurred during follow-up. Added in a model adjusted for age, sex, hypertension, smoking, diabetes, history of MI, history of PCI and left ventricular ejection fraction (LVEF), presence of ischemia was a strong predictor for MACE in the whole cohort (hazard ratio (HR)=2.19, 95% confidence intervals (95%CI) 1.53-3.15, p< 0.001). This prognostic association was maintained in patients with low and intermediate pretest probability for MACE (HR=3.11, 95%CI 1.83-5.28, p< 0.001 and HR=1.99, 95%CI 1.12-3.54, p=0.019 respectively). Adding presence of ischemia and LGE significantly improved model discrimination (C-statistic improvement 0.692 to 0.740), beyond a baseline clinical model. Overall NRI by CMR across guideline-based risk categories (low < 1%, intermediate 1%-3%, and high >3%) was 0.181 (95%CI 0.073-0.29, p< 0.05), while continuous NRI was 0.53 (95%CI 0.35-0.73). CMR reclassified 45% of patients at intermediate pretest risk (27.8% to low risk; 17.2% to high risk) with corresponding changes in the observed MACE rates (0.8%/y and 6.1%/y for low and high post-test risk respectively).

Conclusion: In a multicentre cohort of patients with suspected stable CAD, stress CMR effectively reclassified patient risk beyond established clinical variables, especially for those considered at intermediate risk. A CMR negative for ischemia and LGE was associated with a low annual rate of MACE.

Presenting Author(s)

PA

Panagiotis Antiochos

Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.

Primary Author(s)

PA

Panagiotis Antiochos

Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.

Co-Author(s)

Yin Ge

Cardiovascular imaging fellow
Brigham and Women's Hospital

Disclosure: Disclosure information not submitted.
Kevin Steel, DO, FSCMR

Advanced Cardiac Imaging
PeaceHealth Cardiovascular Center

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AS

ABDULLAH SHUAIB

The University of Texas Southwestern Medical Center

Disclosure: Disclosure information not submitted.
SB

Scott E. Bingham, MD

Cardiologist
Revere Health

Disclosure: Disclosure information not submitted.
JM

J. Ronald Mikolich, MD

Professor of Internal Medicine
Northeast Ohio Medical University

Disclosure: Disclosure information not submitted.
John Heitner

Director, Non-Invasive Imaging
New York Presbyterian Hospital

Disclosure: Disclosure information not submitted.
Andrew E. Arai, MD, FSCMR

Chief
National Institutes of Health

Disclosure: Circle CVI (Individual(s) Involved: Self, Products/Services: Cardiac MRI software): Received grants or funds in support of research of related company products.; Corstem (Individual(s) Involved: Self, Products/Services: Cardiac MRI software): Patents and Invention Reports
W. Patricia Bandettini, MD

Senior Research Physician
National Heart, Lung, and Blood Institute, National Institutes of Health

Disclosure: Disclosure information not submitted.
Amit Patel, MD

Associate Professor
University of Chicago

Disclosure: Alnylam (Individual(s) Involved: Self, Products/Services: Patisiran): Speaker/Honoraria; Arterys (Individual(s) Involved: Self, Products/Services: Software): Other Financial or Material Support, software access for research; Astellas (Individual(s) Involved: Self, Products/Services: Regadenoson): Grant/Research Support, Speaker/Honoraria; General Electric: Grant/Research Support; Myocardial Solutions: Grant/Research Support; neosoft (Individual(s) Involved: Self, Products/Services: SuiteHeart): Other Financial or Material Support, research software access; Philips Healthcare: Grant/Research Support
AF

Afshin Farzaneh-Far, MD, PhD

Associate Professor
University of Illinois, Chicago

Disclosure: Disclosure information not submitted.
Subha V. Raman, MD, FSCMR

Professor
Indiana University

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Chetan Shenoy, MD

Assistant Professor
University of Minnesota

Disclosure: Disclosure information not submitted.
JG

Jorge Gonzalez

Director, Advanced Cardiac Imaging
Scripps Clinic Division of Cardiovascular Diseases

Disclosure: Disclosure information not submitted.
Steve Leung, MD, FSCMR

Associate Professor
University of Kentucky

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Dipan Shah, DO, MD

Associate Professor
Houston Methodist DeBakey Heart & Vascular Center

Disclosure: Disclosure information not submitted.
Victor A. Ferrari, MD, FSCMR

Professor of Medicine and Radiology/Chair, Penn CV Imaging Council
University of Pennsylvania Medical Center

Disclosure: Disclosure information not submitted.
Jeanette Schulz-Menger, MD

Lead of working group CMR
Charité – Universitätsmedizin Berlin/Helios

Disclosure: Bayer Healtcare: Consulting Fees (e.g., advisory boards), Speaker/Honoraria
Matthias Stuber, PhD

Professor
University Hospital (CHUV) and University of Lausanne (UNIL)

Disclosure: Disclosure information not submitted.
Orlando P. Simonetti, PhD

Professor
The Ohio State University

Disclosure: Myocardial Solutions: Grant/Research Support; Siemens Healthcare: Grant/Research Support
Raymond Kwong, MD

Director, Cardiac Magnetic Resonance Imaging
Harvard Medical School

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VM

Venkatesh L. Murthy, MD, PhD

Associate Professor
University of Michigan

Disclosure: Disclosure information not submitted.