Key result
Phase-contrast cine CMR-derived coronary flow reserve was significantly decreased in patients with stable coronary artery disease compared to controls (MD -1.48) and predicted MACE (HR 0.52).
Why the study?
Phase-contrast cine CMR of the coronary sinus can measure CFR non-invasively, but its clinical utility has not yet been established across various cardiovascular diseases.
Does phase-contrast cine CMR-derived coronary flow reserve predict major adverse cardiac events in patients with stable CAD?
Meta-Analysis
Does phase-contrast cine CMR-derived coronary flow reserve predict major adverse cardiac events in patients with stable CAD?
CMR-derived CFR is significantly reduced in patients with stable CAD and cardiomyopathies compared to controls, and lower CFR independently predicts major adverse cardiac events in stable CAD.
Phase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method for measuring coronary sinus blood flow and coronary flow reserve (CFR). However, its clinical utility has not yet been established. Here we performed a meta-analysis to clarify the clinical value of CMR-derived CFR in various cardiovascular diseases. An electronic database search was performed of PubMed, Web of Science Core Collection, Cochrane Advanced Search, and EMBASE. We compared the CMR-derived CFR of various cardiovascular diseases (stable coronary artery disease [CAD], hypertrophic cardiomyopathy [HCM], dilated cardiomyopathy [DCM]) and control subjects. We assessed the prognostic value of CMR-derived CFR for predicting major adverse cardiac events (MACE) in patients with stable CAD. A total of 47 eligible studies were identified. The pooled CFR from our meta-analysis was 3.48 (95% confidence interval [CI], 2.98–3.98) in control subjects, 2.50 (95% CI, 2.38–2.61) in stable CAD, 2.01 (95% CI, 1.70–2.32) in cardiomyopathies (HCM and DCM). The meta-analysis showed that CFR was significantly reduced in stable CAD (mean difference [MD] = −1.48; 95% CI, −1.78 to −1.17; p < 0.001; I2 = 0%; p for heterogeneity = 0.33), HCM (MD = −1.20; 95% CI, −1.63 to −0.77; p < 0.001; I2 = 0%; p for heterogeneity = 0.49), and DCM (MD = −1.53; 95% CI, −1.93 to −1.13; p < 0.001; I2 = 0%; p for heterogeneity = 0.45). CMR-derived CFR was an independent predictor of MACE for patients with stable CAD (hazard ratio = 0.52 per unit increase; 95% CI, 0.37–0.73; p < 0.001; I2 = 84%, p for heterogeneity < 0.001). CMR-derived CFR was significantly decreased in cardiovascular diseases, and a decreased CFR was associated with a higher occurrence of MACE in patients with stable CAD. These results suggest that CMR-derived CFR has potential for the pathological evaluation of stable CAD, cardiomyopathy, and risk stratification in CAD.
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Tanigaki et al. (2023) conducted a meta-analysis in Cardiovascular diseases (stable coronary artery disease, hypertrophic cardiomyopathy, dilated cardiomyopathy). Phase-contrast cine cardiovascular magnetic resonance (CMR) derived coronary flow reserve (CFR) vs. Healthy controls was evaluated on Coronary flow reserve (CFR) in stable CAD compared to control subjects (MD -1.48, 95% CI -1.78 to -1.17, p=<0.001). Phase-contrast cine CMR-derived coronary flow reserve was significantly decreased in patients with stable coronary artery disease compared to controls (MD -1.48) and predicted MACE (HR 0.52).
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