November 25, 2020Open Access

Long-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance

WZWenli ZhouAmway (United States)JLJonan Chun Yin LeeQueen Elizabeth Hospital SLSiu Ting LeungUniversity of Hong Kong

Structured PICO

Does a lower stress perfusion CMR-derived MPRI (≤1.47) predict increased risk of MACE in patients with ischemic symptoms but no overt CAD?

Population

218 patients with chest pain/ischemic symptoms without epicardial CAD or myocardial disease, mean age 59 ± 12 years, 49.5% male.

Intervention

Stress perfusion CMR-derived myocardial perfusion reserve index (MPRI) ≤1.47

Comparator

MPRI >1.47

Outcome

Major adverse cardiovascular events (MACE) defined as all-cause death, acute coronary syndrome (ACS), epicardial CAD development, heart failure hospitalization and non-fatal strokecomposite

Stress perfusion CMR-derived MPRI is an independent predictor of medium-term MACE in patients with ischemic symptoms but no overt CAD.

Abstract

OBJECTIVES: This study investigated the prognosis of coronary microvascular disease (CMD) as determined by stress perfusion cardiac magnetic resonance (CMR) in patients with ischemic symptoms but without significant coronary artery disease (CAD). BACKGROUND: Patients with CMD have poorer prognosis with various cardiac diseases. The myocardial perfusion reserve index (MPRI) derived from noninvasive stress perfusion CMR has been established to diagnose microvascular angina with a threshold MPRI 1.47 (hazard ratio HR: 3.14; 95% confidence interval CI: 1.58 to 6.25; p = 0.001). Multivariate Cox regression after adjusting for age and hypertension demonstrated that MPRI was an independent predictor of MACE (HR: 0.10; 95% CI: 0.03 to 0.34; p < 0.001). CONCLUSIONS: Stress perfusion CMR-derived MPRI is an independent imaging marker that predicts MACE in patients with ischemic symptom and no overt CAD over the medium term.

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