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. Ho; Jaspal 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

doi:10.1016/j.jacc.2019.07.074

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

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

188 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.

Original language	English (US)
Pages (from-to)	1741-1755
Number of pages	15
Journal	Journal of the American College of Cardiology
Volume	74
Issue number	14
DOIs	https://doi.org/10.1016/j.jacc.2019.07.074
State	Published - 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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1016/j.jacc.2019.07.074

Find It

Find It at U of M Libraries

Cite this

Kwong, R. Y., Ge, Y., Steel, K., Bingham, S., Abdullah, S., Fujikura, K., Wang, W., Pandya, A., Chen, Y. Y., Mikolich, J. R., Boland, S., Arai, A. E., Bandettini, W. P., Shanbhag, S. M., Patel, A. R., Narang, A., Farzaneh-Far, A., Romer, B., Heitner, J. F., ... Simonetti, O. P. (2019). Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain. Journal of the American College of Cardiology, 74(14), 1741-1755. https://doi.org/10.1016/j.jacc.2019.07.074

Kwong, RY, Ge, Y, Steel, K, Bingham, S, Abdullah, S, Fujikura, K, Wang, W, Pandya, A, Chen, YY, Mikolich, JR, Boland, S, Arai, AE, Bandettini, WP, Shanbhag, SM, Patel, AR, Narang, A, Farzaneh-Far, A, Romer, B, Heitner, JF, Ho, JY, Singh, J, Shenoy, C, Hughes, A, Leung, SW, Marji, M, Gonzalez, JA, Mehta, S, Shah, DJ, Debs, D, Raman, SV, Guha, A, Ferrari, VA, Schulz-Menger, J, Hachamovitch, R, Stuber, M & Simonetti, OP 2019, 'Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain', Journal of the American College of Cardiology, vol. 74, no. 14, pp. 1741-1755. https://doi.org/10.1016/j.jacc.2019.07.074

@article{eb56a3ef14874ca0aacbe85c77910ce4,

title = "Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain",

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.",

keywords = "cost of care, prognosis, stress cardiac magnetic resonance imaging",

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

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: {\textcopyright} 2019 The Authors",

year = "2019",

month = oct,

day = "8",

doi = "10.1016/j.jacc.2019.07.074",

language = "English (US)",

volume = "74",

pages = "1741--1755",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "14",

}

TY - JOUR

T1 - Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain

AU - Kwong, Raymond Y.

AU - Ge, Yin

AU - Steel, Kevin

AU - Bingham, Scott

AU - Abdullah, Shuaib

AU - Fujikura, Kana

AU - Wang, Wei

AU - Pandya, Ankur

AU - Chen, Yi Yun

AU - Mikolich, J. Ronald

AU - Boland, Sebastian

AU - Arai, Andrew E.

AU - Bandettini, W. Patricia

AU - Shanbhag, Sujata M.

AU - Patel, Amit R.

AU - Narang, Akhil

AU - Farzaneh-Far, Afshin

AU - Romer, Benjamin

AU - Heitner, John F.

AU - Ho, Jean Y.

AU - Singh, Jaspal

AU - Shenoy, Chetan

AU - Hughes, Andrew

AU - Leung, Steve W.

AU - Marji, Meera

AU - Gonzalez, Jorge A.

AU - Mehta, Sandeep

AU - Shah, Dipan J.

AU - Debs, Dany

AU - Raman, Subha V.

AU - Guha, Avirup

AU - Ferrari, Victor A.

AU - Schulz-Menger, Jeanette

AU - Hachamovitch, Rory

AU - Stuber, Matthias

AU - Simonetti, Orlando P.

N1 - 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

PY - 2019/10/8

Y1 - 2019/10/8

N2 - 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.

AB - 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.

KW - cost of care

KW - prognosis

KW - stress cardiac magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=85072527971&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072527971&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2019.07.074

DO - 10.1016/j.jacc.2019.07.074

M3 - Article

C2 - 31582133

AN - SCOPUS:85072527971

SN - 0735-1097

VL - 74

SP - 1741

EP - 1755

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 14

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this