Document Detail


Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain.
MedLine Citation:
PMID:  16580532     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study was designed to determine the diagnostic value of adenosine cardiac magnetic resonance (CMR) in troponin-negative patients with chest pain. BACKGROUND: We hypothesized that adenosine CMR could determine which troponin-negative patients with chest pain in an emergency department have coronary artery disease (CAD) or future adverse cardiac events. METHODS: Adenosine stress CMR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction (MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as coronary artery stenosis >50% on angiography, abnormal correlative stress test, new MI, or death. RESULTS: Adenosine perfusion abnormalities had 100% sensitivity and 93% specificity as the single most accurate component of the CMR examination. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis (log-rank test, p = 0.0006 and p < 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosine CMR was a more accurate predictor than cardiac risk factors (p < 0.002). CONCLUSIONS: In patients with chest pain who had MI excluded by troponin-I and non-diagnostic electrocardiograms, an adenosine CMR examination predicted with high sensitivity and specificity which patients had significant CAD during one-year follow-up. Furthermore, no patients with a normal adenosine CMR study had a subsequent diagnosis of CAD or an adverse outcome.
Authors:
W Patricia Ingkanisorn; Raymond Y Kwong; Nicole S Bohme; Nancy L Geller; Kenneth L Rhoads; Christopher K Dyke; D Ian Paterson; Mushabbar A Syed; Anthony H Aletras; Andrew E Arai
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural     Date:  2006-03-20
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  47     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-03     Completed Date:  2006-05-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1427-32     Citation Subset:  AIM; IM    
Affiliation:
Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, and Suburban Hospital, Bethesda, Maryland 20892-1061, USA.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / diagnostic use*
Adult
Aged
Chest Pain / complications*,  diagnosis*,  mortality
Coronary Artery Disease / etiology*
Emergency Medical Services*
Exercise Test*
Female
Follow-Up Studies
Humans
Magnetic Resonance Angiography*
Male
Middle Aged
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Sensitivity and Specificity
Survival Analysis
Chemical
Reg. No./Substance:
58-61-7/Adenosine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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