2023/07 - Complementary prognostic value of stress perfusion imaging and global coronary flow reserve derived from cardiovascular magnetic resonance: a long-term cohort study [Journal Club]-July Journal Club

Video Transcription

Video Summary

This JCMR Journal Club session introduced Episode 7, Season 4, focused on the prognostic value of stress perfusion CMR combined with global coronary flow reserve (CFR) measured from coronary sinus flow. The study, presented by Satoshi Nakamura, followed 933 patients with suspected or known coronary artery disease over a median of 5.3 years.<br /><br />Stress perfusion CMR alone showed good diagnostic and prognostic value, but it has limitations because visual analysis is qualitative and may miss microvascular dysfunction or the severity of ischemia. Global CFR helped fill that gap. Patients were divided into four groups based on ischemia and CFR status: ischemia with impaired CFR, ischemia with preserved CFR, no ischemia with impaired CFR, and no ischemia with preserved CFR.<br /><br />The key finding was that impaired CFR predicted worse outcomes even when perfusion imaging was normal, and combining CFR with stress perfusion improved risk stratification. The highest event rates occurred in patients with both ischemia and impaired CFR, while patients with either ischemia alone or impaired CFR alone had similar intermediate risk.<br /><br />During the discussion, the panel reviewed technical aspects of coronary sinus flow measurement, the use of ATP stress, image quality issues, and how CFR may reflect microvascular dysfunction as well as severe epicardial disease. The session ended with CME and follow-up information for attendees.

Keywords

stress perfusion CMR

global coronary flow reserve

coronary sinus flow

prognostic value

coronary artery disease

microvascular dysfunction

ischemia risk stratification

ATP stress

cardiac imaging