Cardiac Magnetic Resonance in Stable Coronary Artery Disease: Added Prognostic Value to Conventional Risk Profiling

Figure 1. First pass dipyridamole stress perfusion and late gadolinium enhancement CMR assessment. Case 1 shows a positive stress perfusion study in two coronary territories by reason of a basal-mid anterior (partially) transmural as well as of a basal inferoseptal and mid inferior subendocardial stress perfusion defects (upper images) without late gadolinium enhancement (lower images). Case 2 depicts a negative stress perfusion study because of a mid anteroseptal and inferoseptal subendocardial stress perfusion defect (upper images) matching a similar late gadolinium enhancement area (lower images).

Figure 2. Study enrollment flow chart. Final cohort enrolled in the study after considering exclusion criteria and patients lost at follow-up.

Figure 3. Independent prognostic value of stress perfusion defects and late gadolinium enhancement at CMR. Cox proportional model all-cause mortality-free (left panels) and MACE-free (right panels) survival curves, adjusted for all other significant variables. They show that the presence of ischemia in more than 10% of LV mass (ISCH+) is not independently associated with all-cause mortality whereas it predicts the occurrence of MACE (upper panels). Conversely, the presence of scar in more than 40% of LV mass (LGE+) is independently associated with both all-cause mortality and MACE (lower panel). Follow-up period is truncated to 100 months. P value is derived with the log-rank test. MACE = major adverse cardiac event; CMR = cardiovascular magnetic resonance.