Improved Detection of Coronary Artery Disease by Stress Perfusion Cardiovascular Magnetic Resonance With the Use of Delayed Enhancement Infarction Imaging

Klem, Igor; Heitner, John F.; Shah, Dipan J.; Sketch, Michael H.; Behar, Victor S.; Weinsaft, Jonathan W.; Cawley, Peter J.; Parker, Michele; Elliott, Michael D.; Judd, Robert M.; Kim, Raymond J.

doi:10.1016/j.jacc.2005.10.074

Cited by 372 publications

(292 citation statements)

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“…The diagnostic performance of CMR and exercise ECG according to CAD severity is shown in Tables 4 and 5. CMR stress testing (including LGE, according to the diagnostic algorithm proposed by Klem at al [14]. ) had higher sensitivity (85% vs 50%; P = 0.02), higher specificity (94% vs 73%; P = 0.01), and higher diagnostic accuracy (91% vs 66%; P = 0.0007) compared with exercise ECG.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, invasive CA is not necessarily the ideal gold-standard for comparison as functional significance of coronary obstruction and luminal diameter stenosis are moderately correlated. Furthermore it is important to keep in mind that the algorithm used for CMR analysis [14] is intended to detect significant obstruction of the epicardial coronaries compared to invasive CA (e.g. >70% stenosis).…”

Section: Discussionmentioning

confidence: 99%

“…Details of the CMR scan protocol and analysis have been reported previously [14]. In brief, steady-state free-precession cine images for assessment of LV function were acquired in multiple short-axis (every cm throughout the LV) and 3 long-axis views.…”

Section: Methodsmentioning

confidence: 99%

“…In cases consensus could not be achieved an additional senior observer (H.M.), also blinded to all patient information, made the final decision. Regional parameters were assessed using a 17-segment model as previously described for cine and LGE [14,20]. A perfusion defect was defined as a regional dark area, that 1) persisted for >2 beats while other regions enhanced during the first-pass of contrast through the LV myocardium, and 2) involved the subendocardium.…”

Section: Methodsmentioning

confidence: 99%

“…Stress perfusion CMR has been shown previously to accurately diagnose CAD in the clinical setting in a mixed gender population [14] as well as in women [15]. The aim of the present study was to compare exercise ECG (ST-segment deviation alone) and the DTS with CMR stress testing for the detection of CAD in women with invasive coronary angiography as the gold standard.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Greulich

Bruder

Parker

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundExercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed.Methods and resultsWe prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA.Exercise ECG, CMR and CA was completed in 68 females (age 66.4 ± 8.8 years, number of CAD risk factors 3.5 ± 1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was −3.0 ± 5.4 and was similar in those with and without CAD (−4.5 ± 5.8 and −2.4 ± 5.1; P = 0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P = 0.02, specificities 94% and 73%, P = 0.01, and accuracies 91% and 66%, P = 0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94 ± 0.03 vs 0.56 ± 0.07; P = 0.0001).ConclusionsIn women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Greulich

Bruder

Parker

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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Prognostic Value of Vasodilator Stress Cardiac Magnetic Resonance Imaging

et al. 2019

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IMPORTANCE Stress cardiac magnetic resonance imaging (CMR) is not widely used in current clinical practice, and its ability to predict patient mortality is unknown. OBJECTIVE To determine whether stress CMR is associated with patient mortality. DESIGN, SETTING, AND PARTICIPANTS Real-world evidence from consecutive clinically ordered CMR examinations. Multicenter study of patients undergoing clinical evaluation of myocardial ischemia. Patients with known or suspected coronary artery disease (CAD) underwent clinical vasodilator stress CMR at 7 different hospitals. An automated process collected data from the finalized clinical reports, deidentified and aggregated the data, and assessed mortality using the US Social Security Death Index. MAIN OUTCOMES AND MEASURES All-cause patient mortality. RESULTS Of the 9151 patients, the median (interquartile range) patient age was 63 (51-70) years, 55% were men, and the median (interquartile range) body mass index was 29 (25-33) (calculated as weight in kilograms divided by height in meters squared). The multicenter automated process yielded 9151 consecutive patients undergoing stress CMR, with 48 615 patient-years of follow-up. Of these patients, 4408 had a normal stress CMR examination, 4743 had an abnormal examination, and 1517 died during a median follow-up time of 5.0 years. Using multivariable analysis, addition of stress CMR improved prediction of mortality in 2 different risk models (model 1 hazard ratio [HR], 1.83; 95% CI, 1.63-2.06; P < .001; model 2: HR, 1.80; 95% CI, 1.60-2.03; P < .001) and also improved risk reclassification (net improvement: 11.4%; 95% CI, 7.3-13.6; P < .001). After adjustment for patient age, sex, and cardiac risk factors, Kaplan-Meier survival analysis showed a strong association between an abnormal stress CMR and mortality in all patients (

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Cardiac Imaging

Abidov

Berman

2012

Cardiovascular Clinical Trials

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Improved Detection of Coronary Artery Disease by Stress Perfusion Cardiovascular Magnetic Resonance With the Use of Delayed Enhancement Infarction Imaging

Abstract: A combined perfusion and infarction CMR examination with a visual interpretation algorithm can accurately diagnose CAD in the clinical setting. The combination is superior to perfusion-CMR alone.

Cited by 372 publications

References 28 publications

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Prognostic Value of Vasodilator Stress Cardiac Magnetic Resonance Imaging

Cardiac Imaging

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