Methods: Two hundred and forty-six consecutive patients (61 females, main age 61.96±10.05 years) who underwent dipyridamole stress-CMR in a high volume CMR Laboratory were considered. Abnormal wall motion at rest and after dipyridamole, perfusion at stress and at rest, and late gadolinium enhancement (LGE) were analysed.
End-points were "major non-fatal cardiac events" (ventricular arrhythmias, coronary syndromes, heart failure hospitalization) and cardiac death.
Results: Mean left ventricular ejection fraction was 60.45±13.47% and myocardial fibrosis was detected in 95 (38.6%) patients.
An abnormal stress CMR was found in 65 (26.4%) patients; 39 patients had a reversible stress perfusion defect in at least one myocardial segment and 26 a reversible stress perfusion defect plus worsening of stress wall motion in comparison with rest.
During a median follow up of 60.59 months (IQ range 41.98 months), 69 patients (28.0%) experienced major nonfatal cardiac events. LGE, reversible perfusion deficit, age, diabetes and family history were univariate prognosticators. In the multivariate analysis the independent predictive factors were reversible perfusion deficit (hazard ratio-HR=2.21, P=0.001) and diabetes (HR=2.21, P=0.003).
Ten patients died during follow-up and reversible motion abnormality and LGE were univariate prognosticators. At multivariate analysis, LGE remained a significant prognosticator (HR=10.83, P=0.026), after adjusting for age and diabetes.
When the composite end-point (cardiac events + death) was considered, both myocardial fibrosis and reversible perfusion deficit resulted to be significant univariate prognosticators, in addition to age, diabetes and family history. At multivariate analysis the independent predictive factors were reversible perfusion deficit (HR=2.26, P<0.0001) and diabetes (HR=2.59, P<0.0001) (Figure 1).
Conclusions: Reversible perfusion deficit and diabetes identify patients at high risk of fatal and non fatal cardiac events. LGE is a strong predictor for death in patients with known or suspected CAD.