Incremental prognostic value of coronary flow reserve determined by phase-contrast cine cardiovascular magnetic resonance of the coronary sinus in patients with diabetes mellitus

Journal of Cardiovascular Magnetic Resonance

Tae Iwasawa¹  Mai Azuma²  Kazuki Fukui²  Sho Kodama²  Kazuo Kimura³  Daisuke Utsunomiya⁴  Shingo Kato⁵  Kouichi Tamura⁶ 

[1] Department Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan;Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan;Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan;Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan;Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan;Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan;Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Japan;

关键词: Diabetes mellitus;    Coronary flow reserve;    Magnetic resonance imaging;    Phase contrast;    Coronary sinus;    Prognosis;   

DOI  :  10.1186/s12968-020-00667-3

来源: Springer

【 摘 要 】

BackgroundAlthough non-invasive assessment of coronary flow reserve (CFR) by cardiovascular magnetic resonance (CMR) provides prognostic information for patients with diabetes mellitus (DM), the incremental prognostic value of CMR-derived CFR remains unclear.PurposeTo evaluate the incremental prognostic value of CMR-derived CFR for patients with DM who underwent stress CMR imaging.Materials and methodsA total of 309 patients with type 2 DM [69 ± 9 years; 244 (78%) male] assessed between 2009 and 2019 were retrospectively reviewed. Coronary sinus blood flow (CSBF) was measured using phase contrast (PC) cine CMR. CFR was calculated as the CSBF during adenosine triphosphate infusion divided by that at rest. Major adverse cardiac events (MACE) were defined as death, acute coronary syndrome, hospitalization due to heart failure exacerbation, or sustained ventricular tachycardia. The incremental prognostic value of CFR over clinical and CMR variables was assessed by calculating the C-index and net reclassification improvement (NRI).ResultsDuring a median follow-up of 3.8 years, 42 patients (14%) experienced MACE. The annualized event rate was significantly higher among patients with CFR < 2.0, regardless of the presence of late gadolinium enhancement (LGE) (1.4% vs. 9.8%, p = 0.011 in the LGE (−) group; 1.8% vs. 16.9%, p < 0.001 in the LGE (+) group). In addition, this trend was maintained in the subgroups stratified by presence or absence of ischemia (0.3% vs. 6.7%, p = 0.007 in the ischemia (−) group; 3.9% vs. 17.1%, p = 0.001 in the ischemia (+) group). Adding CFR to the risk model (age + gender + left ventricular ejection fraction + %LGE + %ischemia) resulted in a significant increase of the C-index from 0.838 to 0.870 (p = 0.038) and an NRI of 0.201 (0.004–0.368, p = 0.012).ConclusionPC cine CMR-derived CFR of the coronary sinus may be useful as a prognostic marker for DM patients, incremental to common clinical and CMR parameters. Due to the high prevalence of coronary microvascular dysfunction, the addition of CFR to conventional vasodilator stress CMR imaging may improve risk stratification for patients with DM.

【 授权许可】

CC BY