| Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain. | |
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MedLine Citation:
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PMID: 19772587 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Approximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance (AS-CMR) is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients. METHODS: We studied 103 patients, mean 56.7 + or - 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress (adenosine) and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 (range 161-462) days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease (>50% coronary stenosis on invasive angiography) and coronary revascularization. RESULTS: In 14 patients (13.6%), AS-CMR was positive. The remaining 89 patients (86.4%), who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary end-point during follow-up. The negative predictive value of AS-CMR was 100%. CONCLUSION: AS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis. |
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Authors:
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Stamatios Lerakis; Dalton S McLean; Athanasios V Anadiotis; Matthew Janik; John N Oshinski; Nikolaos Alexopoulos; Elisa Zaragoza-Macias; Emir Veledar; Arthur E Stillman |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-09-21 |
Journal Detail:
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Title: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance Volume: 11 ISSN: 1532-429X ISO Abbreviation: J Cardiovasc Magn Reson Publication Date: 2009 |
Date Detail:
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Created Date: 2009-10-08 Completed Date: 2009-12-02 Revised Date: 2010-06-18 |
Medline Journal Info:
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Nlm Unique ID: 9815616 Medline TA: J Cardiovasc Magn Reson Country: England |
Other Details:
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Languages: eng Pagination: 37 Citation Subset: IM |
Affiliation:
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Department of Medicine and Division of Cardiology, Emory University School of Medicine, 1365 Clifton Road NE, Suite AT-500-508, Atlanta GA, 30322, USA. sleraki@emory.edu |
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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complications,
diagnosis*,
mortality Adenosine / diagnostic use* Adult Aged Angina Pectoris / diagnosis*, etiology, mortality Chest Pain / diagnosis*, etiology, mortality Coronary Stenosis / complications, diagnosis*, mortality, therapy Female Humans Magnetic Resonance Imaging, Cine* Male Middle Aged Myocardial Infarction / diagnosis, etiology, therapy Myocardial Revascularization Patient Discharge Patient Readmission Predictive Value of Tests Prognosis Retrospective Studies Risk Assessment Severity of Illness Index Time Factors |
| Chemical | |
Reg. No./Substance:
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58-61-7/Adenosine |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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