feasibility and prognostic value of stress-perfusion cmr in obesity

ORAL PRESENTATION Open Access Feasibility and prognostic value of stress- perfusion CMR in obesity Ravi Shah * , Otavio R Coelho-Filho, Tomas G Neilan, Bobby Heydari, Ron Blankstein, Yucheng Chen, Eri Watanabe, Michael Jerosch-Herold, Raymond Kwong From 15th Annual SCMR Scientific Sessions Orlando, FL, USA. 2-5 February 2012 Background Obesity is an emerging population at high risk for cardiac events for which robust stress imaging techniques are necessary. Stress-perfusion CMR has high image resolution and is less affected by tissue attenuation com- pared to nuclear scintigraphy. However, its prognostic value in obese patients has not been determined. We hypothesized that stress-perfusion CMR can effectively prognosticate obese patients with suspected myocardial ischemia. Methods 313 obese patients (body mass index BMI ≥ 30 kg/m2) referred for vasodilator stress-perfusion CMR for clinical indications between December 2001-August 2011 were evaluated. Stepwise Cox proportional hazards models were used to identify predictors of cardiac death or acute MI. Death was adjudicated as cardiac if there was antecedent MI or significant cardiac events within 30 days or if sudden and without a clear non-cardiac rea- son of death. Results The median BMI was 35 (IQR 6.3) kg/m2, and average age was 56±12 years. Of 313 patients referred, 300 (96%) unOnly 13 (4%) failed to complete vasodilator stress-perfusion CMR (side effects to stress agent, 3; claustrophobia or patient request, 6; no IV access, 1; gating failure, 2; discovery of LV thrombus, 1). Thirty- two percent had abnormal stress perfusion and 34% had LGE. Mean LVEF was 57.2±14.6% and LV mass index 62.4±19.3 g/m2. Follow-up for vital status was available in all patients with a median follow-up of 3.61 years (range 0.5 to 7.9 years). There were 35 cardiac deaths and 34 acute MI. In a univariate Cox regression, patient age (hazard ratio HR = 1.08, P = .006), history of MI (HR = 9.84, P = .0001) or PCI (HR = 7.76, P = .0005), presence of ischemia (HR = 16.64, P = .0003), LGE (HR = 15.78, P = .01), and a presence of left bundle branch block (HR = 5.07, P = .02) predicted cardiac death or MI. In a stepwise multivariate Cox regression model, a history of percutaneous coronary intervention (LRc2 14.92, P = .0001), presence (LRc2 8.17, P = .004) and extent of Perf defect (LRc2 21.5, P < .0001) were the only independent predictors of cardiovascular death or MI. A negative stress-perfusion CMR was associated with a 98% event-free survival during the study period. Conclusions Assessment of obese patients with stress-perfusion CMR is effective and well-tolerated. The absence of a CMR stress-perfusion defect in obese patients portends an excellent negative cardiac event rate of 98%. Funding RVS was supported by a Post-Doctoral Fellowship Grant from the American Heart Association (11POST000002). RYK and MJH are supported by grants from the National Institutes of Health (RO1HL091157 to RYK, 1RO1HL090634 to MJH). Published: 1 February 2012 doi:10.1186/1532-429X-14-S1-O2 Cite this article as: Shah et al.: Feasibility and prognostic value of stress- perfusion CMR in obesity. Journal of Cardiovascular Magnetic Resonance 2012 14(Suppl 1):O2. Brigham and Women’s Hospital, Boston, MA, USA Shah et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):O2 http://www.jcmr-online.com/content/14/S1/O2 © 2012 Shah et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Page 1: Feasibility and prognostic value of stress-perfusion CMR in obesity

ORAL PRESENTATION Open Access

Feasibility and prognostic value of stress-perfusion CMR in obesityRavi Shah*, Otavio R Coelho-Filho, Tomas G Neilan, Bobby Heydari, Ron Blankstein, Yucheng Chen, Eri Watanabe,Michael Jerosch-Herold, Raymond Kwong

From 15th Annual SCMR Scientific SessionsOrlando, FL, USA. 2-5 February 2012

BackgroundObesity is an emerging population at high risk for car-diac events for which robust stress imaging techniquesare necessary. Stress-perfusion CMR has high imageresolution and is less affected by tissue attenuation com-pared to nuclear scintigraphy. However, its prognosticvalue in obese patients has not been determined. Wehypothesized that stress-perfusion CMR can effectivelyprognosticate obese patients with suspected myocardialischemia.

Methods313 obese patients (body mass index BMI ≥ 30 kg/m2)referred for vasodilator stress-perfusion CMR for clinicalindications between December 2001-August 2011 wereevaluated. Stepwise Cox proportional hazards modelswere used to identify predictors of cardiac death oracute MI. Death was adjudicated as cardiac if there wasantecedent MI or significant cardiac events within 30days or if sudden and without a clear non-cardiac rea-son of death.

ResultsThe median BMI was 35 (IQR 6.3) kg/m2, and averageage was 56±12 years. Of 313 patients referred, 300(96%) unOnly 13 (4%) failed to complete vasodilatorstress-perfusion CMR (side effects to stress agent, 3;claustrophobia or patient request, 6; no IV access, 1;gating failure, 2; discovery of LV thrombus, 1). Thirty-two percent had abnormal stress perfusion and 34% hadLGE. Mean LVEF was 57.2±14.6% and LV mass index62.4±19.3 g/m2. Follow-up for vital status was availablein all patients with a median follow-up of 3.61 years(range 0.5 to 7.9 years). There were 35 cardiac deaths

and 34 acute MI. In a univariate Cox regression, patientage (hazard ratio HR = 1.08, P = .006), history of MI(HR = 9.84, P = .0001) or PCI (HR = 7.76, P = .0005),presence of ischemia (HR = 16.64, P = .0003), LGE (HR= 15.78, P = .01), and a presence of left bundle branchblock (HR = 5.07, P = .02) predicted cardiac death orMI. In a stepwise multivariate Cox regression model, ahistory of percutaneous coronary intervention (LRc214.92, P = .0001), presence (LRc2 8.17, P = .004) andextent of Perf defect (LRc2 21.5, P < .0001) were theonly independent predictors of cardiovascular death orMI. A negative stress-perfusion CMR was associatedwith a 98% event-free survival during the study period.

ConclusionsAssessment of obese patients with stress-perfusion CMRis effective and well-tolerated. The absence of a CMRstress-perfusion defect in obese patients portends anexcellent negative cardiac event rate of 98%.

FundingRVS was supported by a Post-Doctoral Fellowship Grantfrom the American Heart Association (11POST000002).RYK and MJH are supported by grants from theNational Institutes of Health (RO1HL091157 to RYK,1RO1HL090634 to MJH).

Published: 1 February 2012

doi:10.1186/1532-429X-14-S1-O2Cite this article as: Shah et al.: Feasibility and prognostic value of stress-perfusion CMR in obesity. Journal of Cardiovascular Magnetic Resonance2012 14(Suppl 1):O2.

Brigham and Women’s Hospital, Boston, MA, USA

Shah et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):O2http://www.jcmr-online.com/content/14/S1/O2

© 2012 Shah et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.

http://creativecommons.org/licenses/by/2.0