Key result
Reduced stress myocardial blood flow on CMR is linked to ~2.6-fold higher major cardiovascular events risk per unit decrease.
Why the study?
Quantitative myocardial perfusion indices predict outcomes in native vessel disease, but their prognostic performance in patients with prior CABG was unknown.
Does quantitative stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) derived from perfusion mapping CMR predict all-cause mortality and major adverse cardiovascular events in patients with prior CABG?
Cohort (n=341)
CMR operators analysing conventional first pass perfusion images visually were blinded to the study outcome results
No
Does quantitative stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) derived from perfusion mapping CMR predict all-cause mortality and major adverse cardiovascular events in patients with prior CABG?
Global stress myocardial blood flow and myocardial perfusion reserve derived from quantitative CMR perfusion mapping independently predict death and major adverse cardiovascular events in patients with prior CABG, incremental to visual ischemia assessment and scar extent.
Answers are grounded in this paper and cite their sources.
Global stress MBF on perfusion CMR was associated with death or MACE post-CABG; extends native-vessel findings but remains hypothesis-generating.
Background: Patients with prior coronary artery bypass graft (CABG) surgery typically have complex coronary disease and remain at high risk of adverse events. Quantitative myocardial perfusion indices predict outcomes in native vessel disease, but their prognostic performance in patients with prior CABG is unknown. Objectives: To evaluate whether global stress myocardial blood flow (MBF) and perfusion reserve (MPR) derived from perfusion mapping cardiac magnetic resonance (CMR) independently predict adverse outcomes in patients with prior CABG. Methods: Retrospective analysis of consecutive patients with prior CABG referred for adenosine stress perfusion CMR. Perfusion mapping was performed in-line with automated quantification of myocardial blood flow. Primary outcome was a composite of all-cause mortality and major adverse cardiovascular events defined as non-fatal myocardial infarction and unplanned revascularization. Associations were evaluated using Cox proportional hazards models after adjusting for comorbidities and CMR parameters. Results: 341 patients (median age 67 years, 86% male) were included. Over a median follow up of 638 days (IQR 367, 976), 81 (24%) patients reached the primary outcome. Both stress MBF and MPR independently predicted outcomes after adjusting for known prognostic factors (regional ischaemia, infarction). The adjusted hazard ratio (HR) for 1ml/g/min decrease in stress MBF was 2.56 (95%CI, 1.45–4.35) and for 1unit decrease in MPR the adjusted HR was 1.61 (95%CI, 1.08–2.38). Conclusions Global stress MBF and MPR derived from perfusion CMR, independently predict adverse outcomes in patients with prior CABG. This effect is independent of the presence of regional ischemia on visual assessment and the extent of previous infarction.
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Seraphim et al. (2022) conducted a cohort in Prior coronary artery bypass graft (CABG) surgery (n=341). Global stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) derived from quantitative perfusion mapping CMR (per 1 ml/g/min decrease in stress MBF) vs. Higher stress MBF / MPR (continuous exposure variable in Cox regression) was evaluated on Composite of all-cause mortality and major adverse cardiovascular events (non-fatal myocardial infarction and unplanned coronary revascularization >90 days post CMR) (Adjusted HR 2.56 per 1 ml/g/min decrease in stress MBF, 95% CI 1.45-4.35). Each 1 ml/g/min decrease in global stress myocardial blood flow on perfusion CMR independently predicted death or major cardiovascular events in patients with prior CABG.
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