Key result
Combined single-session CMR effectively stratified AF patients with chest pain prior to PVI, with stress-negative patients demonstrating a 99.6% 1-year event-free survival rate.
Why the study?
Does a combined single-session CMR protocol effectively stratify risk in AF patients with chest pain syndromes prior to PVI?
Cohort (n=357)
Does a combined single-session CMR protocol effectively stratify risk in AF patients with chest pain syndromes prior to PVI?
A combined single-session CMR protocol integrating stress perfusion and 3D angiography is a time-efficient and effective tool for stratifying AF patients with chest pain prior to PVI.
May support pre-PVI risk stratification with combined CMR in AF patients with chest pain; leaves open impact on outcomes.
AIMS: To determine the clinical utility of a combined single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating adenosine stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation (AF) patients referred for pulmonary vein isolation (PVI) and complaining about chest pain syndromes. METHODS AND RESULTS: The preprocedural CMR examination (adenosine stress perfusion, late gadolinium enhancement, and three-dimensional pulmonary vein angiography) was performed in 357 consecutive AF patients with chest pain syndromes referred for PVI. Stress perfusion results were used for stratification: ischaemia positive patients underwent invasive coronary angiography, ischaemia negative patients underwent PVI, and follow-up/outcome data were collected (combined primary endpoint of cardiac death/non-fatal myocardial infarction). The integrated CMR protocol had a high success rate (356/357, 99.7%), a short total examination duration (<30 min in all patients), and delivered high-quality three-dimensional pulmonary vein angiography in all patients undergoing PVI (324/324, 100%). Variants of pulmonary vein anatomy were identified in 33% of all patients (117/357). Stress positivity (28/356, 8%) had a high positive predictive value for identification of obstructive coronary artery disease (86%), while stress negativity carried a low short-term event rate following PVI (cumulative 1-year event-free survival rate, 99.6%). CONCLUSION: Combined single-session CMR as a routine diagnostic workup for AF patients with chest pain syndromes prior to PVI proved to represent a time-efficient and effective stratification tool.
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Oebel et al. (2019) conducted a cohort in Atrial fibrillation with chest pain syndromes (n=357). Combined single-session cardiovascular magnetic resonance was evaluated on Combined primary endpoint of cardiac death/non-fatal myocardial infarction. Combined single-session CMR effectively stratified AF patients with chest pain prior to PVI, with stress-negative patients demonstrating a 99.6% 1-year event-free survival rate.
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