Feasibility and Prognostic Value of Vasodilator Stress Perfusion CMR in Patients With Atrial Fibrillation

OBJECTIVES The aim of this study was to assess the feasibility and prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in patients with atrial fibrillation (AF). BACKGROUND Because most studies have excluded arrhythmic patients, the prognostic value of stress perfusion CMR in patients with AF is unknown. METHODS Between 2008 and 2018, consecutive patients with suspected or stable chronic coronary artery disease and AF referred for vasodilator stress perfusion CMR were included and followed for the occurrence of major adverse cardiovascular event(s) (MACE), defined as cardiovascular death or nonfatal myocardial infarction. The diagnosis of AF was defined by 12-lead electrocardiography before and after CMR. Univariate and multivariate Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. RESULTS Of 639 patients (mean age 72 +/- 9 years, 77% men), 602 (94%) completed the CMR protocol, and 538 (89%) completed follow-up (median 5.1 years); 80 had MACE. Using Kaplan-Meier analysis, the presence of ischemia (hazard ratio [HR]: 7.56; 95% confidence interval [CI]: 4.86 to 11.80) or LGE (HR: 2.41; 95% CI: 1.55 to 3.74) was associated with the occurrence of MACE (p < 0.001 for both). In a multivariate Cox regression including clinical and CMR indexes, the presence of ischemia (HR: 5.98; 95% CI: 3.68 to 9.73) or LGE (HR: 2.61; 95% CI: 1.89 to 3.60) was an independent predictor of MACE (p < 0.001 for both). CONCLUSIONS In patients with AF, stress perfusion CMR is feasible and has good discriminative prognostic value to predict the occurrence of MACE. (C) 2021 by the American College of Cardiology Foundation.

Automated summary

This study aimed to assess the feasibility and prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in patients with atrial fibrillation (AF). The presence of ischemia or late gadolinium enhancement (LGE) was found to be associated with the occurrence of major adverse cardiovascular event(s) (MACE) in AF patients, and was confirmed as independent predictors of MACE in multivariate analysis. Stress perfusion CMR is feasible and has good discriminative prognostic value to predict the occurrence of MACE in patients with AF.