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

2013; Elsevier BV; Volume: 168; Issue: 4 Linguagem: Inglês

10.1016/j.ijcard.2013.07.114

1874-1754

Eulália Pereira, Nuno Bettencourt, Nuno Ferreira, Andreas Schuster, Amedeo Chiribiri, João Primo, Madalena Teixeira, Lino Simões, Adelino Leite‐Moreira, José Silva‐Cardoso, Vasco Gama, Eike Nagel,

Coronary Interventions and Diagnostics

Cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) is considered a state-of-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.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 >40% with FFR ≤ 0.8 in vessels >2 mm or ≥90% stenosis/occlusion.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 low-probability 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).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.