Long-Term Prognostic Value of Stress Perfusion Cardiovascular Magnetic Resonance Imaging

Purpose of review The purpose of this review is to analyze the long-term prognostic value of stress perfusion cardiovascular magnetic resonance (CMR) in patients with suspected or known coronary artery disease (CAD). Recent findings Stress perfusion CMR provides high diagnostic accuracy for detection of CAD, with high sensitivity and relatively lower specificity. A normal stress perfusion CMR examination is highly predictive of overall low patient risk. Conversely, abnormal stress perfusion CMR results are associated with mortality and increased risk for adverse cardiac-related events. Stress perfusion CMR is a useful and robust tool for risk reclassification across different CAD risk categories, and most significant for patients of intermediate risk. Stress CMR is reliable for excluding clinically significant coronary artery disease in patients presenting with low-risk acute chest pain. An ischemic burden threshold of less than 1.5 cardiac segments has been found to be most appropriate for safe deferral from revascularization therapy. A stress perfusion CMR-guided strategy has been shown to be noninferior compared to fractional flow reserve (FFR) for revascularization in patients with stable CAD. In clinical practice, CMR offers a multiplicity of useful techniques besides stress perfusion which may add significant prognostic value when combined with the findings of the stress test itself. Summary Stress perfusion CMR is an accurate noninvasive diagnostic test for patients with suspected CAD and provides strong prognostic value across different risk categories.