Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation

Abstract

Purpose Cardiovascular magnetic resonance (CMR) perfusion has been established as a useful imaging modality for the detection of coronary artery disease (CAD). However, there are several limitations when applying standard, ECG-gated stress/rest perfusion CMR to patients with atrial fibrillation (AF). In this study we investigate an approach with no ECG gating and a rapid rest/stress perfusion protocol to determine its accuracy for detection of CAD in patients with AF. Methods 26 patients with AF underwent a rapid rest/regadenoson stress CMR perfusion imaging protocol, and all patients had X-ray coronary angiography. An ungated radial myocardial perfusion sequence was used. Imaging protocol included: rest perfusion image acquisition, followed nearly immediately by administration of regadenoson to induce hyperemia, 60 second wait, and stress image acquisition. CMR perfusion images were interpreted by three blinded readers as normal or abnormal. Diagnostic accuracy was evaluated by comparison to X-ray angiography. Results 21 of the CMR rest/stress perfusion scans were negative, and 5 were positive by angiography criteria. Majority results of the ungated datasets from all of the readers showed a sensitivity, specificity and accuracy of 80%, 100% and 96%, respectively, for detection of CAD. Conclusions An ungated, rapid rest/stress regadenoson perfusion CMR protocol appears to be useful for the diagnosis of obstructive CAD in patients with AF.

Long‐term prognostic value of vasodilator stress cardiac magnetic resonance in patients with atrial fibrillation

“…The subset of patients that did undergo invasive angiography possibly had a higher clinical burden including persistent or aggravating symptoms to warrant an invasive approach despite a negative perfusion CMR. The findings on Regadenoson stress CMR show a promising potential to further improve specificity and accuracy in this challenging patient group 16 . Considering the poor performance of SPECT in patients with AF, 13 and the lack of reliable data on CT‐FFR regarding prognosis and especially in patients with AF, 27 vasodilator perfusion CMR constitutes a valuable diagnostic tool in patients with known or suspected CAD and AF.…”

“…The findings on Regadenoson stress CMR show a promising potential to further improve specificity and accuracy in this challenging patient group. 16 Considering the poor performance of SPECT in patients with AF, 13 and the lack of reliable data on CT‐FFR regarding prognosis and especially in patients with AF, 27 vasodilator perfusion CMR constitutes a valuable diagnostic tool in patients with known or suspected CAD and AF.…”

“…Adenosine‐stress perfusion CMR has good accuracy for the diagnosis of relevant CAD and is a valuable tool for the identification of patients at high risk for major adverse cardiac events (MACE) 9,14,15 . However, the presence of AF poses substantial challenges to image acquisition and interpretation of the results 16,17 . Prior studies showed good short‐term follow‐up 18,19 and good prognostic implications in low‐risk to intermediate‐risk cohorts, 20,21 but long‐term implications in patients at high risk for cardiac events remain insufficiently investigated.…”

“… 9 , 14 , 15 However, the presence of AF poses substantial challenges to image acquisition and interpretation of the results. 16 , 17 Prior studies showed good short‐term follow‐up 18 , 19 and good prognostic implications in low‐risk to intermediate‐risk cohorts, 20 , 21 but long‐term implications in patients at high risk for cardiac events remain insufficiently investigated. The purpose of this study was hence to investigate the diagnostic accuracy and long‐term prognostic value of vasodilator stress perfusion CMR in patients with AF and high cardiovascular (CV) risk at a targeted follow‐up of 5 years.…”

Cardiovascular imaging 2017 in the International Journal of Cardiovascular Imaging

“…Stress perfusion CMR in combination with LGE and wall motion analysis was found to be accurate and feasible for diagnosing coronary artery disease in children [59]. Ungated perfusion CMR using regadenoson was found to be accurate for the diagnosis of obstructive coronary artery disease in patients with atrial fibrillation [60]. Yin et al found that abnormal perfusion can be identified in non-LGE and non-hypertrophic segments in patients with hypertrophic cardiomyopathy [61].…”