Incremental prognostic value of coronary flow reserve determined by phase-contrast cine cardiovascular magnetic resonance of the coronary sinus in patients ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-10-08

AUTHORS

Shingo Kato, Kazuki Fukui, Sho Kodama, Mai Azuma, Tae Iwasawa, Kazuo Kimura, Kouichi Tamura, Daisuke Utsunomiya

ABSTRACT

BackgroundAlthough non-invasive assessment of coronary flow reserve (CFR) by cardiovascular magnetic resonance (CMR) provides prognostic information for patients with diabetes mellitus (DM), the incremental prognostic value of CMR-derived CFR remains unclear.PurposeTo evaluate the incremental prognostic value of CMR-derived CFR for patients with DM who underwent stress CMR imaging.Materials and methodsA total of 309 patients with type 2 DM [69 ± 9 years; 244 (78%) male] assessed between 2009 and 2019 were retrospectively reviewed. Coronary sinus blood flow (CSBF) was measured using phase contrast (PC) cine CMR. CFR was calculated as the CSBF during adenosine triphosphate infusion divided by that at rest. Major adverse cardiac events (MACE) were defined as death, acute coronary syndrome, hospitalization due to heart failure exacerbation, or sustained ventricular tachycardia. The incremental prognostic value of CFR over clinical and CMR variables was assessed by calculating the C-index and net reclassification improvement (NRI).ResultsDuring a median follow-up of 3.8 years, 42 patients (14%) experienced MACE. The annualized event rate was significantly higher among patients with CFR < 2.0, regardless of the presence of late gadolinium enhancement (LGE) (1.4% vs. 9.8%, p = 0.011 in the LGE (−) group; 1.8% vs. 16.9%, p < 0.001 in the LGE (+) group). In addition, this trend was maintained in the subgroups stratified by presence or absence of ischemia (0.3% vs. 6.7%, p = 0.007 in the ischemia (−) group; 3.9% vs. 17.1%, p = 0.001 in the ischemia (+) group). Adding CFR to the risk model (age + gender + left ventricular ejection fraction + %LGE + %ischemia) resulted in a significant increase of the C-index from 0.838 to 0.870 (p = 0.038) and an NRI of 0.201 (0.004–0.368, p = 0.012).ConclusionPC cine CMR-derived CFR of the coronary sinus may be useful as a prognostic marker for DM patients, incremental to common clinical and CMR parameters. Due to the high prevalence of coronary microvascular dysfunction, the addition of CFR to conventional vasodilator stress CMR imaging may improve risk stratification for patients with DM. More... »

PAGES

73

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12968-020-00667-3

DOI

http://dx.doi.org/10.1186/s12968-020-00667-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1131497397

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/33028350


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68 gadolinium enhancement
69 heart failure exacerbation
70 high prevalence
71 hospitalization
72 imaging
73 improvement
74 increase
75 incremental prognostic value
76 information
77 infusion
78 ischemia
79 late gadolinium enhancement
80 magnetic resonance
81 major adverse cardiac events
82 markers
83 materials
84 mellitus
85 methodsA total
86 microvascular dysfunction
87 model
88 net reclassification improvement
89 non-invasive assessment
90 parameters
91 patients
92 presence
93 prevalence
94 prognostic information
95 prognostic marker
96 prognostic value
97 rate
98 reclassification improvement
99 reserves
100 resonance
101 rest
102 risk model
103 risk stratification
104 significant increase
105 sinus
106 sinus blood flow
107 stratification
108 stress cardiovascular magnetic resonance
109 subgroups
110 syndrome
111 tachycardia
112 total
113 trends
114 triphosphate infusion
115 type 2 diabetes mellitus
116 values
117 variables
118 vasodilators
119 ventricular tachycardia
120 years
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