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Prognostic Value of Qualitative and Quantitative Stress Cmr in Patients With Known or Suspected Cad Publisher Pubmed



Yarahmadi P1, 2 ; Forouzannia SM3 ; Forouzannia SA4 ; Malik SB5 ; Yousefifard M6 ; Nguyen PK1, 2
Authors
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Authors Affiliations
  1. 1. Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
  2. 2. Stanford Cardiovascular Institute, Stanford, CA, United States
  3. 3. Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Department of Radiology, Division of Cardiovascular Imaging, Stanford University, Stanford, CA, United States
  6. 6. Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran

Source: JACC: Cardiovascular Imaging Published:2024


Abstract

Background: Recent studies suggest that quantitative cardiac magnetic resonance (CMR) may have more accuracy than qualitative CMR in coronary artery disease (CAD) diagnosis. However, the prognostic value of quantitative and qualitative CMR has not been compared systematically. Objectives: The objective was to conduct a systematic review and meta-analysis assessing the utility of qualitative and quantitative stress CMR in the prognosis of patients with known or suspected CAD. Methods: A comprehensive search was performed through Embase, Scopus, Web of Science, and Medline. Studies that used qualitative vasodilator CMR or quantitative CMR assessments to compare the prognosis of patients with positive and negative CMR results were extracted. A meta-analysis was then performed to assess: 1) major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction (MI), unstable angina, and coronary revascularization; and 2) cardiac hard events defined as the composite of cardiac death and nonfatal MI. Results: Forty-one studies with 38,030 patients were included in this systematic review. MACE occurred significantly more in patients with positive qualitative (HR: 3.86; 95% CI: 3.28-4.54) and quantitative (HR: 4.60; 95% CI: 1.60-13.21) CMR assessments. There was no significant difference between qualitative and quantitative CMR assessments in predicting MACE (P = 0.75). In studies with qualitative CMR assessment, cardiac hard events (OR: 7.21; 95% CI: 4.99-10.41), cardiac death (OR: 5.63; 95% CI: 2.46-12.92), nonfatal MI (OR: 7.46; 95% CI: 3.49-15.96), coronary revascularization (OR: 6.34; 95% CI: 3.42-1.75), and all-cause mortality (HR: 1.66; 95% CI: 1.12-2.47) were higher in patients with positive CMR. Conclusions: The presence of myocardial ischemia on CMR is associated with worse clinical outcomes in patients with known or suspected CAD. Both qualitative and quantitative stress CMR assessments are helpful tools for predicting clinical outcomes. © 2024 American College of Cardiology Foundation
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