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CLINICAL RESEARCH

Prognostic Value of Dipyridamole Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

Vicente Bodi, MD, FESC^_*,_*, Juan Sanchis, MD, FESC^_*, Maria P. Lopez-Lereu, MD, Julio Nunez, MD^_*, Luis Mainar, MD^_*, Jose V. Monmeneu, MD, Oliver Husser, MD^_*, Eloy Dominguez, MD^_*, Francisco J. Chorro, MD, FESC^_* and Angel Llacer, MD, FESC^_*

^_* Cardiology Department, University Clinic Hospital, University of Valencia, Valencia, Spain
Exploraciones Radiológicas Especiales Sociedad Anónima, Valencia, Spain

Manuscript received February 27, 2007; revised manuscript received June 5, 2007, accepted June 19, 2007.

^_* Reprint requests and correspondence: Dr. Vicente Bodi, Cardiology Department, University Clinic Hospital, Blasco Ibanez 17, 46010 Valencia, Spain. (Email: vicentbodi{at}hotmail.com).

Objectives: We evaluated the prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging (CMR) in patients with chest pain and known or suspected coronary artery disease.

Background: Stress perfusion CMR has been incorporated in daily practice. Data on its prognostic value are preliminary.

Methods: Dipyridamole stress CMR was performed in 420 patients with chest pain and known or suspected coronary artery disease. The extent (number of segments according to the 17-segment model) of abnormal wall motion at rest (AWM-rest), abnormal wall motion with dipyridamole (AWM-D), perfusion deficit (at stress first-pass perfusion imaging), and delayed enhancement (at late enhancement imaging) were analyzed.

Results: During a median follow-up of 420 days, 41 major adverse cardiac events (MACE), including 9 cardiac deaths, 14 nonfatal myocardial infarctions, and 18 readmissions for unstable angina with documented abnormal angiography, were documented. The MACE were more frequent in patients with significant (>1 segment) AWM-rest (22% vs. 5%), AWM-D (21% vs. 4%), perfusion deficit (17% vs. 5%), and delayed enhancement (20% vs. 6%; p <0.0001 in all cases). In a multivariate analysis adjusted for baseline characteristics, the extent of AWM-D was independently related to MACE (hazard ratio [HR] 1.15 [95% confidence interval (CI) 1.06 to 1.24] per segment; p = 0.0006) and to major events (cardiac death or nonfatal myocardial infarction; HR 1.15 [95% CI 1.05 to 1.26] per segment; p = 0.002).

Conclusions: Dipyridamole stress CMR is useful for predicting the outcome of patients with known or suspected coronary artery disease.

Abbreviations and Acronyms   AWM-D = extent (number of segments) of abnormal wall motion with dipyridamole   AWM-rest = extent (number of segments) of abnormal wall motion at rest   CMR = cardiovascular magnetic resonance imaging   MACE = major adverse cardiac events   TrueFISP = true fast imaging with steady-state precession sequence

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