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

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

Masaki Ishida MD, PhD, Abstract Co-Author: Nothing to Disclose

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

Shiro Nakamori MD, Abstract Co-Author: Nothing to Disclose

Hajime Sakuma MD, Presenter: Departmental Research Grant, Siemens AG Departmental Research Grant, Koninklijke Philips Electronics NV Departmental Research Grant, General Electric Company Departmental Research Grant, Bayer AG Departmental Research Grant, Eisai Co, Ltd Departmental Research Grant, Guerbet SA

Previous studies demonstrated that myocardial scar on late gadolinium enhanced (LGE) MRI and LV dysfunction on cine MRI provide independent prognostic information for future cardiac events. Although whole heart coronary MRA permits noninvasive detection of coronary artery disease, the additional prognostic value of coronary MRA in cardiac MR study has not been investigated. The purpose of this study was to determine the prognostic value of coronary MRA in predicting major adverse cardiac events (MACE) in comparison with LGE MRI and cine MRI.

Cine MRI, LGE MRI and whole heart coronary MRA were acquired by using a 1.5T MR system and 32 channel cardiac coils in 178 patients (mean age, 68±10 years; male 61%) with suspected CAD but without known CAD. Two observers determined LV ejection fraction (LVEF), presence and extent of LGE, and presence of obstructive CAD on MR images. MACEs were defined as cardiac death, acute myocardial infarction, unstable angina, heart failure, and ventricular arrhythmia.

During a median follow-up period of 26 months (interquartile range, 16-33 months), MACEs were observed in 12 patients (1 cardiac death, 9 unstable angina, 2 heart failure). LVEF < 50% (hazard ratio [HR], 1.933; 95% confidence interval [CI], 16.27-18.340; p, 0.017), presence of LGE (HR, 7.539; 95% CI, 2.267-25.073; p, 0.001) and presence of significant stenosis (HR, 16.990; 95% CI, 2.193-131.623; p=0.007) were significantly associated with increased risk for MACE. When adjusted to a model that combines patient age, sex, LVEF < 50% and LGE, significant stenosis on coronary MRA remained an independent predictor for MACE.

The presence of significant stenosis on coronary MRA independently predicted subsequent cardiac events. Use of coronary MRA in conjunction with cine MRI and LGE MRI can provide improved risk stratification of patients with suspected CAD.

Coronary arterial stenosis detected by whole heart coronary MRA is a strong and independent predictor of future cardiac event, and could make a unique contribution to patient risk stratification.

Yoon, Y, Kitagawa, K, Ishida, M, Nakajima, H, Nakamori, S, Sakuma, H, Prognostic Value of Coronary MRA in Patients with Suspected Coronary Artery Disease: Comparison with Late Gadolinium Enhanced MRI and Cine MRI.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12029409.html