Dipyridamole cardiac MR imaging predicted major events in patients with ischemic chest pain, with a 14% event rate in those with inducible wall motion abnormalities versus 2% in normal scans (P<.001).
Cohort (n=1,722)
Yes
Does dipyridamole cardiac MR imaging predict major events in patients with ischemic chest pain?
Dipyridamole cardiac MR imaging effectively stratifies risk in patients with ischemic chest pain, with inducible wall motion abnormalities identifying those at highest risk who may benefit most from revascularization.
Absolute Event Rate: 14% vs 2%
p-value: p=<.001
PURPOSE: To evaluate dipyridamole cardiac magnetic resonance (MR) imaging in the prediction of major events (MEs) in patients with ischemic chest pain in a large multicenter registry. MATERIALS AND METHODS: Institutional ethics committee approval and written informed consent were obtained. A total of 1722 patients who were undergoing cardiac MR imaging for chest pain were included. Wall motion abnormalities (WMAs) at rest, hyperemia perfusion defect (PD), late gadolinium enhancement (LGE), and inducible WMA were analyzed (abnormal if more than one abnormal segment was seen) with the 17-segment model. A cardiac MR categorization was created: category 1, no PD, LGE, or inducible WMA; category 2, PD without LGE and inducible WMA; category 3, LGE without inducible WMA; and category 4, inducible WMA. The association with ME was analyzed by using Cox proportional hazard regression multivariate models. RESULTS: During a median follow-up period of 308 days, 61 MEs (4%) occurred (36 cardiac deaths, 25 nonfatal myocardial infarctions). MEs were associated with a greater extent of WMA, PD, LGE, and inducible WMA (P ≤ .001 for all analyses). In multivariable analyses, PD (P = .002) and inducible WMA (P = .0001) were the only cardiac MR predictors. ME rate in categories 1, 2, 3, and 4 was 2% (14 of 901 patients), 3% (six of 219 patients), 4% (15 of 409 patients), and 14% (26 of 193 patients), respectively (category 4 vs category 1, adjusted P < .001). Cardiac MR-directed revascularization was performed in 242 patients (14%) and reduced the risk of ME in only category 4 (7% six of 92 patients vs 26% 26 of 101 patients, P = .0004). CONCLUSION: Dipyridamole cardiac MR imaging can be used to predict MEs in patients with ischemic chest pain. Patients with inducible WMA are at the highest risk for MEs and benefit the most from revascularization.
Bodı́ et al. (Tue,) conducted a cohort in ischemic chest pain (n=1,722). Dipyridamole cardiac MR imaging (inducible wall motion abnormality) vs. Normal scan (no perfusion defect, late gadolinium enhancement, or inducible wall motion abnormality) was evaluated on Major events (cardiac deaths, nonfatal myocardial infarctions) (p=<.001). Dipyridamole cardiac MR imaging predicted major events in patients with ischemic chest pain, with a 14% event rate in those with inducible wall motion abnormalities versus 2% in normal scans (P<.001).
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