Impaired coronary flow reserve determined by MR measurement of coronary sinus flow predicts adverse outcome in patients with known or suspected coronary artery disease
© Ishida et al; licensee BioMed Central Ltd. 2013
Published: 30 January 2013
Recent studies demonstrated that 82Rb PET-derived myocardial perfusion reserve has a significant prognostic impact on the prediction of cardiac events in patients assessed for myocardial ischemia. Regional myocardial ischemia and late gadolinium enhancement (LGE) defined by cardiac MR imaging are also reported as significant prognosticators for future cardiac events. However, the prognostic value of coronary flow reserve (CFR) obtained by MR flow measurement remains uncertain. The aim of this study was to evaluate the prognostic value of CFR determined by phase contrast cine MR imaging of the coronary sinus in patients with known or suspected coronary artery disease (CAD).
203 patients (mean age, 65±13 years; male, 57%) with known or suspected CAD underwent cardiac MR studies including phase contrast cine MRI of coronary sinus, and stress-rest perfusion and LGE MR imaging. The patients with previous revascularization were excluded from this study. Presence or absence of regional ischemia in ≥2 AHA segments and LGE in any myocardial segment were visually determined on stress-rest perfusion and LGE MRI, respectively. CFR was obtained as the ratio of coronary sinus flow assessed by phase contrast cine MRI at baseline and during ATP stress and categorized in tertile (lower, <1.5; middle, 1.5 to 2.0; upper 2.0<). MACEs were defined as cardiac death, late revascularization (>90days), acute myocardial infarction, unstable angina, heart failure, and ventricular arrhythmia.
CFR quantified by phase contrast cine MR imaging of the coronary sinus can predicts future major cardiac events in patients with known or suspected CAD independent of the conventional cardiac MR predictors such as presence of regional ischemia and infarction.
Departmental research funding.
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