Incremental value of adenosine stress cardiac magnetic resonance in coronary artery disease detection

• Type: Article in International Scientific Journal
• Date: 2013

Authors

Pereira, E (Author) Other; Bettencourt, N (Author) Other; Ferreira, N (Author) Other; Schuster, A (Author) Other; Chiribiri, A (Author) Other; Primo, J (Author) Other; Teixeira, M (Author) Other; Simoes, L (Author) Other; Leite-Moreira AF (Author) FMUP; Silva Cardoso, J (Author) FMUP; Gama, V (Author) Other; Nagel, E (Author) Other

Journal

Title: International Journal of Cardiology

Vol. 168

Pages: 4160-4167

ISSN: 0167-5273

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 11 Citations

Scopus - 11 Citations

Other information

Authenticus ID: P-008-FHK

DOI: 10.1016/j.ijcard.2013.07.114

Abstract (EN): Introduction: Cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) is considered a stateof- the-art non-invasive modality for ischemia detection but its additive value in a multiple-test strategy in patients with suspected coronary artery disease (CAD) is not fully validated. We aimed to evaluate CMR-MPI integration with exercise treadmill test (ETT) for the diagnostic workup of patients with suspected CAD, having invasive fractional flow reserve (FFR) as reference standard. Methods: In this prospective single-center study, patients with suspected CAD underwent sequential ETT, CMR-MPI and X-ray invasive coronary angiography (XA). Significant CAD was defined by the presence of stenosis N40% with FFR <= 0.8 in vessels >2 mmor >= 90% stenosis/occlusion. Results: 80 symptomatic patients (68% male, 61 +/- 8 years) were enrolled. Compared to ETT, CMR-MPI showed similar sensitivity (81%) and higher specificity (93 vs. 58%, p < 0.001) for CAD detection (prevalence = 46%) translating into better diagnostic performance (AUC 0.87 vs. 0.70; p = 0.002). CMR-MPI improved accuracy independently of ETT in all patients with high pre-test probability and in intermediate-probability patients but those with a clearly positive-ETT (symptoms + ST-shift), in whom ETT correctly identified CAD. In the lowprobability group CMR-MPI was useful as a gatekeeper for XA after a positive-ETT. The best integrating protocol achieved a global accuracy of 89% (AUC 0.88) and was clearly superior to an approach based solely in ETT (AUC 0.70, p < 0.001), yet similar to isolated CMR-MPI (AUC 0.87, p = ns). Conclusions: CMR-MPI has high sensitivity and specificity for CAD detection and may be combined with ETT in a diagnostic workflow aiming to increase accuracy and reduce the number of unnecessary catheterizations.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8