Stress CMR imaging a safe, valuable option when treating HFrEF patients

Vasodilator stress perfusion cardiovascular magnetic resonance (CMR) imaging is safe and effective when treating patients with heart failure with reduced ejection fraction (HFrEF), according to new findings published in Circulation: Cardiovascular Imaging.

“Heart failure represents a leading cause of morbidity and mortality worldwide, and coronary artery disease is the primary risk factor for heart failure development,” wrote lead author Théo Pezel, MD, a cardiologist from the Cardiovascular Magnetic Resonance Laboratory in Massy, France, and colleagues. “Risk stratification is therefore highly needed in patients with heart failure, but functional noninvasive tests are often limited by limited capacity of exercise or a less optimal hemodynamic response to intravenous vasodilator. As a result, risk stratification and prognostic data are missing in this population.”

The study included more than 1,000 patients with HFrEF who received care from December 2008-2018 at a single tertiary cardiovascular center. The mean patient age was 64.9 years old.  

All patients were referred for vasodilator stress perfusion CMR for the detection of myocardial ischemia (MI). The median left ventricular ejection fraction (LVEF) was 38.7%, and patients were excluded from the study if their LVEF was 40% or greater. Patients diagnosed with hypertrophic cardiomyopathy or cardiac amyloidosis were also excluded, though patients with atrial fibrillation were included. A follow-up occurred in yearly intervals, with additional appointments if necessary.

Overall, the authors noted, stress CMR “was well tolerated without any adverse events” and inducible ischemia was found to be “a strong and independent predictor” of major adverse cardiovascular events (MACEs). While 11.96% of patients with ischemia and late gadolinium enhancement (LGE) experienced a major adverse cardiovascular event (MACE), the rate for patients without ischemia or LGE was just 1.79%.

“With growing diagnostic and prognostic implications, the data suggest an increased value of stress CMR in this population,” the team concluded.