Circulation Reports
Online ISSN : 2434-0790
Ischemic Heart Disease
Prognostic Value of Integrated Assessment of Cardiac Magnetic Resonance-Derived Global Coronary Flow Reserve and Cardiopulmonary Exercise Testing-Derived Peak Oxygen Consumption in Patients With Acute Myocardial Infarction
Tomoyo Sugiyama, Yoshihisa Kanaji, Masahiro Hoshino, Masahiro Hada, Yoshihiro Hanyu, Tatsuhiro Nagamine, Kai Nogami, Hiroki Ueno, Kazuki Matsuda, Kodai Sayama, Tatsuya Sakamoto, Eisuke Usui, Nobutaka Wakasa, Takashi Umino, Ippei Hamano, Manabu Yamamoto, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta
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Keywords: Acute myocardial infarction, Cardiac magnetic resonance imaging, Cardiopulmonary exercise testing, Coronary flow reserve, Peak oxygen consumption
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2024 Volume 6 Issue 7 Pages 255-262

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Abstract

Background: This study investigated the prognostic value of cardiovascular magnetic resonance (CMR)-derived global coronary flow reserve (G-CFR) in addition to cardiopulmonary exercise testing (CPET) variables in patients with acute myocardial infarction (AMI).

Methods and Results: We investigated 127 patients with AMI who underwent primary or urgent percutaneous coronary intervention (PCI) and post-intervention CMR and CPET. The incidence of major cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent non-fatal myocardial infarction, re-hospitalization due to congestive heart failure, and stroke, was evaluated (median follow-up, 2.8 years). Patients with MACCE (n=14) had lower ejection fraction (EF) (50 [43–59] vs. 58 [51–63]%; P=0.014), lower G-CFR (1.74 [1.19–2.20] vs. 2.40 [1.61–3.66]; P=0.008), and lower peak oxygen consumption (V̇O2) (15.16±2.64 vs. 17.19±3.70 mL/kg/min; P=0.049) than patients without MACCE. G-CFR<2.33 and peak V̇O2<15.65 mL/kg/min (cut-off values derived from receiver operating characteristic curve analyses) were significantly associated with the incidence of MACCE (log-rank test, P=0.01). The combination of low G-CFR and low peak V̇O2improved risk discrimination for MACCE when added to the reference clinical model including age, male sex, post-PCI peak creatine kinase, EF, and left anterior descending artery culprit lesion.

Conclusions: G-CFR and peak V̇O2showed incremental prognostic information compared with the reference model using historically important clinical risk factors, indicating that this approach may help identify high-risk patients who suffer subsequent adverse events.

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© 2024, THE JAPANESE CIRCULATION SOCIETY

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