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Prognostic Significance of CMR Findings in Patients with Known Coronary Artery Disease – Experience from a South Asian Country

Authors
  • Ahmed, Syed Waqar1
  • Sultan, Fateh Ali Tipoo1
  • Awan, Safia2
  • Ahmed, Imran3
  • 1 Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi , (Pakistan)
  • 2 Department of Medicine, Aga Khan University Hospital, Karachi , (Pakistan)
  • 3 Department of Radiology, Aga Khan University Hospital, Karachi , (Pakistan)
Type
Published Article
Journal
Journal of Clinical Imaging Science
Publisher
Scientific Scholar
Publication Date
Nov 21, 2020
Volume
10
Identifiers
DOI: 10.25259/JCIS_153_2020
PMID: 33274119
PMCID: PMC7708965
Source
PubMed Central
Keywords
Disciplines
  • Original Research
License
Green

Abstract

Objectives: South Asians (SA) have a higher burden of coronary artery disease (CAD) and are known to have a worse prognosis compared to other ethnicities. Therefore, it is imperative to improve the risk stratification of SA patient with CAD and to seek out newer prognostic markers beyond the conventional echocardiography.The aim of this study was to investigate whether variables obtained by cardiac magnetic resonance (CMR) improve risk stratification of South Asian patients with known CAD. Material and Methods: We retrospectively analyzed 147 patients with evidence of CAD that had a CMR at our center between January 2011 and January 2019. LV volumes and regional wall motions were acquired by cine images, while infarct size (IS) was measured by late gadolinium enhancement. At a mean follow-up of 3.36 ± 2.22 years, cardiac events (non-fatal myocardial infarction, hospitalization due to heart failure, life-threatening arrhythmia, or cardiac death) occurred in 49 patients. An IS ≥35%, left ventricular ejection fraction (LVEF) ≤31%, and a wall motion score index (WMSI) ≥1.9 were strongly associated with follow-up cardiac events ( P < 0.001). Patients that had none or less than 3 of these factors, showed a lower risk of cardiac events (HR 0.22 CI [0.11–0.44] P < 0.001 and HR 0.12 CI [0.04–0.32] P < 0.001, respectively) compared to those with all three factors. Conclusion: Integration of CMR derived factors such as IS and WMSI with LVEF can improve the prognostication of the SA population with CAD. Better risk stratification of patients can lead to improved and cost-effective therapeutic strategies to ameliorate the prognosis of these patients.

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