Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain

Raymond Y. Kwong, Yin Ge, Kevin Steel, Scott Bingham, Shuaib Abdullah, Kana Fujikura, Wei Wang, Ankur Pandya, Yi Yun Chen, J. Ronald Mikolich, Sebastian Boland, Andrew E. Arai, W. Patricia Bandettini, Sujata M. Shanbhag, Amit R. Patel, Akhil Narang, Afshin Farzaneh-Far, Benjamin Romer, John F. Heitner, Jean Y. HoJaspal Singh, Chetan Shenoy, Andrew Hughes, Steve W. Leung, Meera Marji, Jorge A. Gonzalez, Sandeep Mehta, Dipan J. Shah, Dany Debs, Subha V. Raman, Avirup Guha, Victor A. Ferrari, Jeanette Schulz-Menger, Rory Hachamovitch, Matthias Stuber, Orlando P. Simonetti

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background: Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies. Objectives: This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States. Methods: In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates. Results: In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up. In contrast, patients with ischemia+/LGE+ experienced a >4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers. Conclusions: In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891)

Original languageEnglish (US)
Pages (from-to)1741-1755
Number of pages15
JournalJournal of the American College of Cardiology
Volume74
Issue number14
DOIs
StatePublished - Oct 8 2019

Bibliographical note

Funding Information:
The SPINS Registry was funded by the Society for Cardiovascular Magnetic Resonance, using a research grant jointly sponsored by Siemens Healthineers (Erlangen, Germany) and Bayer AG (Leverkusen, Germany). These sponsors to the Society for Cardiovascular Magnetic Resonance provided financial support for the study but did not play a role in study design, data collection, analysis, interpretation, or manuscript drafting. Dr. Arai has research agreements with Siemens, Bayer, and Circle Cardiovascular Imaging. Dr. Bandettini is the principal investigator of one of the Bayer-sponsored GadaCAD2 (Gadavist-Enhanced Cardiac Magnetic Resonance Imaging to Detect Coronary Artery Disease) sites. Dr. Patel has received a research grant from and served on the Speakers Bureau of Astellas. Dr. Schulz-Menger has research agreements with Siemens; and serves on the Advisory Board of Bayer. Dr. Stuber has received nonmonetary research support form Siemens Healthineers. Drs. Raman and Simonetti both receive institutional research support from Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2019 The Authors

Keywords

  • cost of care
  • prognosis
  • stress cardiac magnetic resonance imaging

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