Author + information
- Received April 20, 2020
- Accepted May 18, 2020
- Published online October 5, 2020.
- Yin Ge, MDa,
- Panagiotis Antiochos, MDa,
- Kevin Steel, DOb,
- Scott Bingham, MDc,
- Shuaib Abdullah, MDd,
- Yi-Yun Chen, MD, MPHa,
- J Ronald Mikolich, MDe,
- Andrew E. Arai, MDf,
- W. Patricia Bandettini, MDf,
- Sujata M. Shanbhag, MD, MPHf,
- Amit R. Patel, MDg,
- Afshin Farzaneh-Far, MD, PhDh,
- John F. Heitner, MDi,
- Chetan Shenoy, MDj,
- Steve W. Leung, MDk,
- Jorge A. Gonzalez, MDl,
- Dipan J. Shah, MDm,
- Subha V. Raman, MDn,
- Victor A. Ferrari, MDo,
- Jeanette Schulz-Menger, MDp,
- Matthias Stuber, PhDq,
- Orlando P. Simonetti, PhDn and
- Raymond Y. Kwong, MD, MPHa,∗ ()
- aNoninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- bCardiology Division, San Antonio Military Medical Center, San Antonio, Texas
- cRevere Health, Provo, Utah
- dVeteran Administration North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, Texas
- eDepartment of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania
- fNational Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- gCardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois
- hDivision of Cardiology, University of Illinois at Chicago, Chicago, Illinois
- iDivision of Cardiology, New York Presbyterian–Brooklyn Methodist Hospital, Brooklyn, New York
- jCardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- kGill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
- lDivision of Cardiology and Radiology, Scripps Clinic, La Jolla, California
- mHouston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- nDivision of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
- oCardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- pWorking Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Berlin, Germany
- qDepartment of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland
- ↵∗Address for correspondence:
Dr. Raymond Y. Kwong, Brigham and Women’s Hospital, Cardiovascular Division, Department of Medicine, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115.
Objectives The aim of this study was to investigate the prognostic value of stress cardiac magnetic resonance imaging (CMR) in patients with reduced left ventricular (LV) systolic function.
Background Patients with ischemic cardiomyopathy are at risk from both myocardial ischemia and heart failure. Invasive testing is often used as the first-line investigation, and there is limited evidence as to whether stress testing can effectively provide risk stratification.
Methods In this substudy of a multicenter registry from 13 U.S. centers, patients with reduced LV ejection fraction (<50%), referred for stress CMR for suspected myocardial ischemia, were included. The primary outcome was cardiovascular death or nonfatal myocardial infarction. The secondary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, hospitalization for unstable angina or congestive heart failure, and unplanned late coronary artery bypass graft surgery.
Results Among 582 patients (mean age 62 ± 12 years, 34% women), 40% had a history of congestive heart failure, and the median LV ejection fraction was 39% (interquartile range: 28% to 45%). At median follow-up of 5.0 years, 97 patients had experienced the primary outcome, and 182 patients had experienced the secondary outcome. Patients with no CMR evidence of ischemia or late gadolinium enhancement (LGE) experienced an annual primary outcome event rate of 1.1%. The presence of ischemia, LGE, or both was associated with higher event rates. In a multivariate model adjusted for clinical covariates, ischemia and LGE were independent predictors of the primary (hazard ratio [HR]: 2.63; 95% confidence interval [CI]: 1.68 to 4.14; p < 0.001; and HR: 1.86; 95% CI: 1.05 to 3.29; p = 0.03) and secondary (HR: 2.14; 95% CI: 1.55 to 2.95; p < 0.001; and HR 1.70; 95% CI: 1.16 to 2.49; p = 0.007) outcomes. The addition of ischemia and LGE led to improved model discrimination for the primary outcome (change in C statistic from 0.715 to 0.765; p = 0.02). The presence and extent of ischemia were associated with higher rates of use of downstream coronary angiography, revascularization, and cost of care spent on ischemia testing.
Conclusions Stress CMR was effective in risk-stratifying patients with reduced LV ejection fractions. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891)
The SPINS registry was funded by the Society for Cardiovascular Magnetic Resonance, using a research grant jointly sponsored by Siemens Healthineers and Bayer. These sponsors to the Society for Cardiovascular Magnetic Resonance provided financial support for the study but did not play a role in study design, data collection, analysis, interpretation, or manuscript drafting. Dr. Antiochos has received research funding from the Swiss National Science Foundation (grant P2LAP3_184037), the Novartis Foundation for Medical-Biological Research, the Bangerter-Rhyner Foundation, and the SICPA Foundation. Dr. Arai has research agreements with Siemens, Bayer, and Circle Cardiovascular Imaging. Dr. Bandettini is the principal investigator of one of the Bayer-sponsored GadaCAD2 (Gadavist-Enhanced Cardiac Magnetic Resonance Imaging to Detect Coronary Artery Disease) sites. Dr. Patel has received a research grant from and served on the Speakers Bureau of Astellas. Dr. Schulz-Menger has received research agreements with Siemens; and serves on the Advisory Board of Bayer. Dr. Stuber has received nonmonetary research support form Siemens Healthineers. Drs. Raman and Simonetti both receive institutional research support from Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Borja Ibanez, MD, was Guest Editor on this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received April 20, 2020.
- Accepted May 18, 2020.
- 2020 American College of Cardiology Foundation
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