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. 2021 May 17;23(1):56.
doi: 10.1186/s12968-021-00749-w.

Long-term prognostic value of whole-heart coronary magnetic resonance angiography

Satoshi Nakamura  1 , Masaki Ishida  2 , Kei Nakata  1 , Yasutaka Ichikawa  1 , Shinichi Takase  1 , Masafumi Takafuji  1 , Haruno Ito  1 , Shiro Nakamori  3 , Tairo Kurita  3 , Kaoru Dohi  3 , Hajime Sakuma  1
Affiliations

Long-term prognostic value of whole-heart coronary magnetic resonance angiography

Satoshi Nakamura et al. J Cardiovasc Magn Reson. .

Abstract

Background: Coronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the usefulness of CMRA for risk stratification in short-term follow-up, the long-term prognostic value of CMRA remains unclear. The purpose of this study was to evaluate the long-term prognostic value of CMRA.

Methods: A total of 506 patients without history of myocardial infarction or prior coronary artery revascularization underwent free-breathing whole-heart CMRA between 2009 and 2015. Images were acquired using a 1.5 T or 3 T scanner and visually evaluated as the consensus decisions of two observers. Obstructive CAD on CMRA was defined as luminal narrowing of ≥ 50% in at least one coronary artery. Major adverse cardiac events (MACE) comprised cardiac death, nonfatal myocardial infarction, and unstable angina.

Results: Obstructive CAD on CMRA was observed in 214 patients (42%). During follow-up (median, 5.6 years), 31 MACE occurred. Kaplan-Meier curve analysis revealed a significant difference in event-free survival between patients with and without obstructive CAD for MACE (log-rank, p = 0.003) and cardiac death (p = 0.012). Annualized event rates for MACE in patients with no obstructive CAD, 1-vessel disease, 2-vessel disease, and left-main or 3-vessel disease were 0.6%, 1.5%, 2.3%, and 3.6%, respectively (log-rank, p = 0.003). Cox proportional hazard regression analysis showed that, among obstructive CAD on CMRA and clinical risk factors (age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of CAD), obstructive CAD and diabetes were significant predictors of MACE (hazard ratios, 2.9 [p = 0.005] and 2.2 [p = 0.034], respectively). In multivariate analysis, obstructive CAD remained an independent predictor (adjusted hazard ratio, 2.6 [p = 0.010]) after adjusting for diabetes. Addition of obstructive CAD to clinical risk factors significantly increased the global chi-square result from 8.3 to 13.8 (p = 0.022).

Conclusions: In long-term follow-up, free breathing whole heart CMRA allows non-invasive risk stratification for MACE and cardiac death and provides incremental prognostic value over conventional risk factors in patients without a history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA were associated with worse prognosis. Importantly, patients without obstructive CAD on CMRA displayed favorable prognosis.

Keywords: Coronary artery disease; Coronary magnetic resonance angiography; Long-term prognostic value.

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Conflict of interest statement

Satoshi Nakamura: none; Masaki Ishida: none; Kei Nakata: none; Yasutaka Ichikawa: none; Shinichi Takase: none; Masafumi Takafuji: none; Haruno Ito: none; Shiro Nakamori: none; Tairo Kurita: none; Kaoru Dohi: Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Hajime Sakuma: DAIICHI SANKYO COMPANY, LIMITED, Fuji Pharma Co., Ltd., FUJIFILM RI Pharma Co., Ltd., Eisai Co., Ltd., Guerbet Japan.

Figures

Fig. 1
Fig. 1
Flow chart of patient selection. This figure shows a flow chart of the patient selection in this study. CABG  coronary artery bypass grafting, CMRA  coronary magnetic resonance angiography, MI  myocardial infarction, PCI percutaneous coronary intervention
Fig. 2
Fig. 2
A case in a 66-year-old female with multiple risk factors. The figures illustrate a thin-slab maximum intensity projection image and b invasive coronary angiography that show significant stenosis (red arrow) in the mid portion of the right coronary artery
Fig. 3
Fig. 3
Long-term risk stratification by CMRA. The figures show event-free survival curves in patients stratified by presence or absence of obstructive CAD on CMRA for a MACE and b cardiac death. CAD coronary artery disease, CMRA coronary magnetic resonance angiography, MACE  major cardiac adverse events
Fig. 4
Fig. 4
Risk stratification by the severity of CAD. The figures show a event-free survival curves in patients stratified by the severity of CAD on CMRA for MACE and b annualized event rates according to the severity of CAD. CAD  coronary artery disease, CMRA coronary magnetic resonance angiography, LM left main, MACE  major cardiac adverse events
Fig. 5
Fig. 5
Event-free survival analysis according to 1.5 T or 3 T scanners. The figures show event-free survival curves for presence or absence of obstructive CAD among patients who underwent an CMR scan by field strength. a 1.5 T or b 3 T scanners. CAD  coronary artery disease
Fig. 6
Fig. 6
Incremental value of CMRA over clinical risk factors. The figure shows a global chi-square test that demonstrates incremental prognostic value of CMRA over clinical risk factors (age, sex, hypertension, dyslipidemia, diabetes, smoking, and family history of CAD). CAD  coronary artery disease, CMRA coronary magnetic resonance angiography, LM left main, MACE  major cardiac adverse events
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