Masaki Ishida MD, Presenter: Nothing to Disclose

Yeonyee Elizabeth Yoon, Abstract Co-Author: Nothing to Disclose

Kakuya Kitagawa MD, Abstract Co-Author: Nothing to Disclose

Shingo Kato MD, Abstract Co-Author: Nothing to Disclose

Hiroshi Nakajima MD, Abstract Co-Author: Nothing to Disclose

Hajime Sakuma MD, Abstract Co-Author: Departmental research grant, Toshiba Corporation Departmental research grant, Koninklijke Philips Electronics NV Departmental research grantt, General Electric Company Departmental research grant, Bayer AG Departmental research grant, Eisai Co, Ltd

Recent studies demonstrated that the presence of stenosis on coronary CT angiography has a significant prognostic impact on the prediction of cardiac events. However, data on the prognostic value of whole-heart coronary MR angiography (CMRA) are currently not available. The aim of this study was to determine whether CMRA can predict major adverse cardiac events (MACEs) in patients with suspected coronary artery disease (CAD).

We studied 164 patients (mean age, 68±11 years; male, 63%) with suspected CAD. Non-contrast enhanced, free-breathing whole-heart CMRA images were acquired with a balanced TFE sequence by using a 1.5T MR system and 32 channel cardiac coils. The presence or absence of ≥50% diameter stenosis was visually determined on sliding thin slab MIP images. MACEs were defined as cardiac death, acute myocardial infarction, unstable angina, heart failure, and ventricular arrhythmia.

CMRA revealed significant stenosis in 64 (39%) of 164 subjects. During a median follow-up period of 25 months (range, 7 to 41 months), MACEs were observed in 12 (19%) of 64 subjects with significant stenosis on CMRA and 1 (1%) of 100 subjects without significant stenosis, corresponding to the annual event rate of 8.5% and 0.4%, respectively. Kaplan-Meier curve demonstrated a significantly lower MACE-free survival rate in patients with significant stenosis on CMRA compared to those without significant stenosis (log-rank test, p<0.001). In multivariate Cox regression analysis, adjusting for age, gender, hypertension, diabetes, hyperlipidemia, smoking, family history of premature CAD, and obesity, the presence of significant stenosis was the only independent predictor of MACE (adjusted hazard ratio, 17.54; p=0.006). 

High hazard ratio observed in this study indicated that the presence of significant stenosis on whole heart CMRA is strongly associated with future major cardiac events in patients with suspected CAD. The absence of significant stenosis on CMRA is associated with a very low risk of cardiac events.

Whole-heart coronary MRA permits the risk stratification of patients with suspected CAD without exposing the subjects to radiation or administrating contrast medium.

Ishida, M, Yoon, Y, Kitagawa, K, Kato, S, Nakajima, H, Sakuma, H, Prognostic Value of Free-breathing Whole-Heart Coronary MR Angiography in Predicting Major Adverse Cardiac Events.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004690.html