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Prognostic value of dipyridamole stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a mid-term follow-up study

  • Cardiac
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Abstract

Objectives

Dipyridamole stress cardiac magnetic resonance (CMR) evaluates the key phases (perfusion and wall motion) of the ischemic cascade. We sought to determine the prognostic value of dipyridamole stress-CMR in consecutive patients symptomatic for chest pain.

Methods

Seven hundred and ninety-three consecutive patients symptomatic for chest pain underwent dipyridamole stress-CMR and were followed up for 810 ± 665 days. Patients were classified in group 1 (no- reversible ischemia), group 2 (stress perfusion defect alone), and group 3 [stress perfusion defect plus abnormal wall motion (AWM)]. End points were "all cardiac events" (myocardial infarction, cardiac death and revascularization) and "hard cardiac events" (all cardiac events excluding revascularization).

Results

One hundred and ninety-five (24 %) all cardiac events and 53 (7 %) hard cardiac events were observed. All and hard cardiac event rates in groups 1, 2, and 3 were 11 %, 49 %, 69 % and 4 %, 8 %, 21 %, respectively, with a higher rate in group 2 vs. group 1 (p<0.01) and group 3 vs. groups 1 and 2 (p<0.01). Multivariate analysis showed the presence of late gadolinium enhancement and stress perfusion defect plus AWM as independent predictors of all and hard cardiac events.

Conclusions

Dipyridamole stress-CMR improves prognostic stratification of patients through differentiation between the different components of the ischemic cascade.

Key Points

• Dipyridamole stress cardiac magnetic resonance helps to assess coronary artery disease.

• Novel technique to study the key phases of myocardial ischemia.

• Combined assessment of perfusion and motion defects.

• Dipyridamole stress imaging has additional value for predicting cardiac events.

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Abbreviations

AWM:

abnormal wall motion

CAD:

coronary artery disease

CMR:

cardiac magnetic resonance

ECG:

electrocardiogram

ICA:

invasive coronary angiography

LGE:

late gadolinium enhancement

SD:

standard deviation

SPECT:

single photon emission computed tomography

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Acknowledgments

The scientific guarantor of this publication is Gianluca Pontone. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Fabrizio Veglia kindly provided statistical advice for this manuscript.

One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic and prognostic study, performed at one institution.

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Authors and Affiliations

  1. Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy

    Gianluca Pontone, Daniele Andreini, Erika Bertella, Monica Loguercio, Marco Guglielmo, Andrea Baggiano, Saima Mushtaq, Paola Gripari, Chiara Segurini, Edoardo Conte, Virginia Beltrama, Marta Giovannardi, Fabrizio Veglia, Antonio L. Bartorelli, Piergiuseppe Agostoni & Mauro Pepi

  2. Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy

    Daniele Andreini, Antonio L. Bartorelli & Piergiuseppe Agostoni

  3. Fondazione CNR/Regione Toscana “G. Monasterio”, Pisa, Italy

    Giovanni Donato Aquaro & Pier Giorgio Masci

  4. Institute of Cardiology “G. D’Annunzio”, Chieti, Italy

    Sara Salerni & Carmen Rossi

  5. Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital “Policlinico Consorziale” of Bari, Bari, Italy

    Andrea Igoren Guaricci

Authors
  1. Gianluca Pontone
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  2. Daniele Andreini
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  3. Erika Bertella
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  4. Monica Loguercio
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  5. Marco Guglielmo
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  6. Andrea Baggiano
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  7. Giovanni Donato Aquaro
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  8. Saima Mushtaq
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  9. Sara Salerni
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  13. Edoardo Conte
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  14. Virginia Beltrama
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  15. Marta Giovannardi
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  16. Fabrizio Veglia
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  17. Andrea Igoren Guaricci
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  18. Antonio L. Bartorelli
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  19. Piergiuseppe Agostoni
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  20. Mauro Pepi
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  21. Pier Giorgio Masci
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Corresponding author

Correspondence to Gianluca Pontone.

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Pontone, G., Andreini, D., Bertella, E. et al. Prognostic value of dipyridamole stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a mid-term follow-up study. Eur Radiol 26, 2155–2165 (2016). https://doi.org/10.1007/s00330-015-4064-x

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  • DOI: https://doi.org/10.1007/s00330-015-4064-x

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