Document Detail


Value of cardiovascular magnetic resonance stress perfusion testing for the detection of coronary artery disease in women.
MedLine Citation:
PMID:  19356464     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We wanted to assess the value of cardiovascular magnetic resonance (CMR) stress testing for evaluation of women with suspected coronary artery disease (CAD). BACKGROUND: A combined perfusion and infarction CMR examination can accurately diagnose CAD in the clinical setting in a mixed gender population. METHODS: We prospectively enrolled 147 consecutive women with chest pain or other symptoms suggestive of CAD at 2 centers (Duke University Medical Center, Robert-Bosch-Krankenhaus). Each patient underwent a comprehensive clinical evaluation, a CMR stress test consisting of cine rest function, adenosine-stress and rest perfusion, and delayed-enhancement CMR infarction imaging, and X-ray coronary angiography within 24 h. The components of the CMR test were analyzed visually both in isolation and combined using a pre-specified algorithm. Coronary artery disease was defined as stenosis > or =70% on quantitative analysis of coronary angiography. RESULTS: Cardiovascular magnetic resonance imaging was completed in 136 females (63.0 +/- 11.1 years), 37 (27%) women had CAD on coronary angiography. The combined CMR stress test had a sensitivity, specificity, and accuracy of 84%, 88%, and 87%, respectively, for the diagnosis of CAD. Diagnostic accuracy was high at both sites (Duke University Medical Center 82%, Robert-Bosch-Krankenhaus 90%; p = 0.18). The accuracy for the detection of CAD was reduced when intermediate grade stenoses were included (82% vs. 87%; p = 0.01 compared the cutoff of stenosis > or =50% vs. > or =70%). The sensitivity was lower in women with single-vessel disease (71% vs. 100%; p = 0.06 compared with multivessel disease) and small left ventricular mass (69% vs. 95%; p = 0.04 for left ventricular mass < or =97 g vs. >97 g). The latter difference was even more significant after accounting for end-diastolic volumes (70% vs. 100%; p = 0.02 for left ventricular mass indexed to end-diastolic volume < or =1.15 g/ml vs. >1.15 g/ml). CONCLUSIONS: A multicomponent CMR stress test can accurately diagnose CAD in women. Detection of CAD in women with intermediate grade stenosis, single-vessel disease, and with small hearts is challenging.
Authors:
Igor Klem; Simon Greulich; John F Heitner; Han Kim; Holger Vogelsberg; Eva-Maria Kispert; Srivani R Ambati; Christian Bruch; Michele Parker; Robert M Judd; Raymond J Kim; Udo Sechtem
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  1     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  436-45     Citation Subset:  IM    
Affiliation:
Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina 27710, USA. igor.klem@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adenosine / diagnostic use
Aged
Algorithms
Angina Pectoris / etiology*,  pathology,  physiopathology
Coronary Angiography
Coronary Circulation*
Coronary Stenosis / complications,  diagnosis*,  physiopathology
Europe
Exercise Test
Female
Humans
Image Interpretation, Computer-Assisted
Magnetic Resonance Imaging, Cine*
Middle Aged
Myocardial Perfusion Imaging / methods*
Predictive Value of Tests
Prospective Studies
ROC Curve
Sensitivity and Specificity
Severity of Illness Index
Sex Factors
Stroke Volume
United States
Women's Health*
Grant Support
ID/Acronym/Agency:
R01-HL63268/HL/NHLBI NIH HHS; R01-HL64726/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
58-61-7/Adenosine
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2008 Jul;1(4):446-9   [PMID:  19356465 ]

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