Stress cardiac MRI may effectively predict prognosis in stable chest pain syndromes: JACC

USA: Stress cardiac magnetic resonance imaging (CMR) offers effective cardiac prognosis in patients with stable chest pain syndromes, finds a recent study. Implementation of stress CMR as an initial diagnostic modality may prove less costly than conventional strategies.

According to the study, published in the Journal of the American College of Cardiology, patients without CMR ischemia or LGE (late gadolinium enhancement) experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing.

Stress cardiac magnetic resonance imaging has demonstrated excellent diagnostic and prognostic value in single-centre studies. However, stress CMR remains an underutilized method. Raymond Y. Kwong, Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the US in this retrospective study.

The study involved 2,349 patients (63 ± 11 years of age, 47% female) from 14 centres across 11 states who presented with a chest pain syndrome for stress CMR and followed for a target period of 5 years.

The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates.

Key findings of the study include:

• Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of the primary outcome (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up.


• In contrast, patients with ischemia+/LGE+ experienced a >4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centres.