Bernhard Klumpp MD, Presenter: Nothing to Disclose

Achim Seeger, Abstract Co-Author: Nothing to Disclose

Christiane Bretschneider, Abstract Co-Author: Nothing to Disclose

Patrick Krumm, Abstract Co-Author: Nothing to Disclose

Stephan Miller MD, Abstract Co-Author: Nothing to Disclose

Claus Detlef Claussen MD, Abstract Co-Author: Nothing to Disclose

Ulrich Kramer MD, Abstract Co-Author: Nothing to Disclose

 Cardiac stress perfusion MR-imaging (SPMRI) and delayed enhancement imaging (DEMRI) are established techniques to assess myocardial perfusion and viability. Aim of our study was to assess the correlation of initial extent of myocardial ischemia and infarction with the clinical outcome after revascularization.

 Since 2005 250 patients with clinical symptoms of coronary artery disease (CAD) were included. Myocardial perfusion was assessed using 2D SR-GRE sequences with three slices in short axis angulations (1.5T: TR 2.2ms, TE 1.1ms, flip 12°, matrix 192, slice thickness 8mm, 0.1 mmol Gadobutrol / kg bw (Gadovist, Bayer, Germany)) after pharmacological stress induction by adenosine short infusion. Viability was assessed using DEMRI. MRI was assessed by two experienced observers qualitatively. Standard of reference was invasive coronary angiography. Stenoses >70% were rated hemodynamically relevant. Preliminary 50 patients were evaluated over 5 years regarding the occurrence of cardiac adverse events (CAE)(myocardial infarction, PTCA, Stent, coronary artery bypass grafting).

 Stress induced ischemia was found in 32 patients, additional chronic myocardial infarction (MI) in 20 patients and in 4 patients MI without ischemia. In 22 patients, PTCA was performed (19 stents), in 2 patients coronary artery bypass. During the 5-year follow up 16 re-PTCAs were necessary (12 stents) after 45±23 months in 9 patients, thereof two admitted to emergency ward with acute myocardial infarction, one being lethal. CAE occurred in 6 of 20 (30%) patients with ischemia and MI in the initial MRI, one being lethal, in 2 of 12 (17%) patients with ischemia and in 1 of 4 (25%) with MI without ischemia. None of the 14 patients with neither ischemia nor MI was subject to CAE. 12 of 16 re-PTCAs and both acute MI occurred in patients with previous chronic MI.

 In contrast to good prognosis in patients with ischemia and adequate therapy, prognosis worsens in patients with MI in the initial MRI significantly, especially when combined with simultaneous ischemia. SPMRI without pathologic findings rules out CAE with high probability. The presence of chronic MI is decisive for the prognosis in patients with CAD under adequate therapy.

The presence of MI in MRI has a significantly worse influence on the prognosis of patients with CAD than the extent of ischaemia if treated adequately.

Klumpp, B, Seeger, A, Bretschneider, C, Krumm, P, Miller, S, Claussen, C, Kramer, U,  Prediction of Clinical Outcome in Patients with Coronary Artery Disease by Cardiac Stress Perfusion MRI: 5-year Follow-up.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043639.html