Cardiac Magnetic Resonance Imaging Findings and the Risk of Cardiovascular Events in Patients With Recent Myocardial Infarction or Suspected or Known Coronary Artery Disease – A Systematic Review of Prognostic Studies

OBJECTIVES: Although the diagnostic value of CMR findings is established, the independent prognostic association with future cardiovascular events remains largely unclear. The objective is to review the prognostic value of cardiac magnetic resonance (CMR) imaging findings for future cardiovascular events in patients with a recent myocardial infarction (MI) and patients with suspected or known coronary artery disease (CAD).

METHODS: Studies published until February 2013 identified by systematic MEDLINE and EMBASE searches were reviewed for associations between CMR findings (left ventricular ejection fraction [LVEF], (inducible) wall motion abnormalities [WMA], abnormal myocardial perfusion, microvascular obstruction [MVO], late gadolinium enhancement, edema, intramyocardial haemorrhage), and hard events (all-cause mortality, cardiac death, cardiac transplantation, and myocardial infarction) or major adverse cardiovascular events (MACE: hard events and other cardiovascular events defined by the authors of the evaluated articles) were included.

RESULTS: Fifty-six studies (25,497 patients) were evaluated. For patients with recent MI, too few patients were evaluated to establish associations between CMR findings and hard events. LVEF (range of adjusted Hazard Ratios (adjHRs): 1.03-1.05 per % decrease) was independently associated with MACE. In patients with suspected or known CAD, WMA (adjHR: 1.87-2.99), inducible perfusion defects (adj HR: 3.02-7.77), LVEF (adjHR: 0.72-0.82 per 10% increase), and infarction (adjHR: 2.82-9.43) were independently associated with hard events, and presence of inducible perfusion defects was associated with MACE (adjHRs 1.76-3.21).

CONCLUSIONS: Independent predictors of future cardiovascular events were LVEF for patients with a recent MI and WMA, inducible perfusion defects, LVEF and presence of infarction for patients with suspected or known CAD. 

PMID: 24486280

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