Advanced search
Start date
(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

What Is the Clinical Impact of Stress CMR After the ISCHEMIA Trial?

Full text
Pezel, Theo [1, 2] ; Silva, Luis Miguel [3] ; Bau, Adriana Aparecia [3] ; Teixiera, Adherbal [3] ; Jerosch-Herold, Michael [4, 5] ; Coelho-Filho, Otavio R. [3]
Total Authors: 6
[1] Johns Hopkins Univ, Dept Med, Div Cardiol, Baltimore, MD - USA
[2] Univ Paris, Lariboisiere Hosp, INSERM, Dept Cardiol, UMRS 942, Paris - France
[3] State Univ Campinas UNICAMP, Fac Med Sci, Discipline Cardiol, Campinas - Brazil
[4] Brigham & Womens Hosp, Dept Radiol, 75 Francis St, Boston, MA 02115 - USA
[5] Brigham & Womens Hosp, Noninvas Cardiovasc Imaging Program, 75 Francis St, Boston, MA 02115 - USA
Total Affiliations: 5
Document type: Review article
Web of Science Citations: 0

After progressively receding for decades, cardiovascular mortality due to coronary artery disease has recently increased, and the associated healthcare costs are projected to double by 2030. While the 2019 European Society of Cardiology guidelines for chronic coronary syndromes recommend non-invasive cardiac imaging for patients with suspected coronary artery disease, the impact of non-invasive imaging strategies to guide initial coronary revascularization and improve long-term outcomes is still under debate. Recently, the ISCHEMIA trial has highlighted the fundamental role of optimized medical therapy and the lack of overall benefit of early invasive strategies at a median follow-up of 3.2 years. However, sub-group analyses excluding procedural infarctions with longer follow-ups of up to 5 years have suggested that patients undergoing revascularization had better outcomes than those receiving medical therapy alone. A recent sub-study of ISCHEMIA in patients with heart failure or reduced left ventricular ejection fraction (LVEF <45%) indicated that revascularization improved clinical outcomes compared to medical therapy alone. Furthermore, other large observational studies have suggested a favorable prognostic impact of coronary revascularization in patients with severe inducible ischemia assessed by stress cardiovascular magnetic resonance (CMR). Indeed, some data suggest that stress CMR-guided revascularization assessing the extent of the ischemia could be useful in identifying patients who would most benefit from invasive procedures such as myocardial revascularization. Interestingly, the MR-INFORM trial has recently shown that a first-line stress CMR-based non-invasive assessment was non-inferior in terms of outcomes, with a lower incidence of coronary revascularization compared to an initial invasive approach guided by fractional flow reserve in patients with stable angina. In the present review, we will discuss the current state-of-the-art data on the prognostic value of stress CMR assessment of myocardial ischemia in light of the ISCHEMIA trial results, highlighting meaningful sub-analyses, and still unanswered opportunities of this pivotal study. We will also review the available evidence for the potential clinical application of quantifying the extent of ischemia to stratify cardiovascular risk and to best guide invasive and non-invasive treatment strategies. (AU)

FAPESP's process: 16/26209-1 - Multi-user equipament approved in grat 2015/15402-2: cardiorespiratory diagnostic system
Grantee:Otávio Rizzi Coelho-Filho
Support Opportunities: Multi-user Equipment Program
FAPESP's process: 15/15402-2 - Characterization of interstitial fibrosis and cardiomyocyte hypertrophy by cardiac MRI: implication on early remodeling and on the transition to heart failure
Grantee:Otávio Rizzi Coelho-Filho
Support Opportunities: Research Grants - Young Investigators Grants
FAPESP's process: 17/03708-5 - Multi-user equipament approved in the grant 2015/15402-2: ecocardiograma
Grantee:Otávio Rizzi Coelho-Filho
Support Opportunities: Multi-user Equipment Program