The prognostic value of normal stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: A meta-analysis

Paola Gargiulo, Santo Dellegrottaglie, Dario Bruzzese, Gianluigi Savarese, Oriana Scala, Donatella Ruggiero, Carmen D'Amore, Stefania Paolillo, Piergiuseppe Agostoni, Edoardo Bossone, Andrea Soricelli, Alberto Cuocolo, Bruno Trimarco, Pasquale Perrone Filardi

Research output: Contribution to journalArticlepeer-review

Abstract

Background-Ischemia detection with stress cardiac magnetic resonance (CMR) is typically based on induction of either myocardial perfusion defect or wall motion abnormality. Single-center studies have shown the high value of stress CMR for risk stratification. The aim of this study was to define the prognostic value of stress CMR for prediction of adverse cardiac events in patients with known or suspected coronary artery disease. Methods and Results-Studies published between January 1985 and April 2012 were identified by database search. We included studies using stress CMR to evaluate subjects with known or suspected coronary artery disease and providing primary data on clinical outcomes of nonfatal myocardial infarction or cardiac death with a follow-up time ≥3 months. Total of 14 studies were finally included, recruiting 12 178 patients. The negative predictive value for nonfatal myocardial infarction and cardiac death of normal CMR was 98.12% (95% confidence interval, 97.26-98.83) during a weighted mean follow-up of 25.3 months, resulting in estimated event rate after a negative test equal to 1.88% (95% confidence interval, 1.17-2.74). The corresponding annualized event rate after a negative test was 1.03%. Comparable negative predictive values for major coronary events were obtained in studies considering the absence of inducible perfusion defect compared with those evaluating the absence of inducible wall motion abnormality (98.39% versus 97.31%, respectively; P=0.227 by meta-regression analysis). Conclusions-Stress CMR has a high negative predictive value for adverse cardiac events, and the absence of inducible perfusion defect or wall motion abnormality shows a similar ability to identify low-risk patients with known or suspected coronary artery disease.

Original languageEnglish
Pages (from-to)574-582
Number of pages9
JournalCirculation: Cardiovascular Imaging
Volume6
Issue number4
DOIs
Publication statusPublished - Jul 2013

Keywords

  • Cardiac magnetic resonance imaging
  • Chronic ischemic heart disease
  • Coronary artery disease
  • Prognostic value

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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