Stress Cardiac MR Imaging Compared with Stress Echocardiography in the Early Evaluation of Patients Who Present to the Emergency Department with Intermediate-Risk Chest Pain

Abstract

Purpose:To compare the utility and efficacy of stress cardiac magnetic resonance (MR) imaging and stress echocardiography in an emergency setting in patients with acute chest pain (CP) and intermediate risk of coronary artery disease (CAD). Materials and Methods:Written informed consent was obtained from all patients. This HIPAA-compliant study was approved by the institutional review board for research ethics. Sixty patients without history of CAD presented to the emergency department with intermediate-risk acute CP and were prospectively enrolled. Patients underwent both stress cardiac MR imaging and stress echocardiography in random order within 12 hours of presentation. Stress imaging results were interpreted clinically immediately (blinded interpretation was performed months later), and coronary angiography was performed if either result was abnormal. CAD was considered significant if it was identified at angiography (narrowing .50% ) or if a cardiac event (death or myocardial infarction) occurred during follow-up (mean, 14 months 6 5 [standard deviation]). McNemar test was used to compare the diagnostic accuracy of techniques. Results:Stress cardiac MR imaging and stress echocardiography had similar specificity, accuracy, and positive and negative predictive values (92% vs 96%, 93% vs 88%, 67% vs 60%, and 100% vs 91%, respectively, for clinical interpretation; 90% vs 92%, 90% vs 88%, 58% vs 56%, and 98% vs 94%, respectively, for blinded interpretation). Stress cardiac MR imaging had higher sensitivity at clinical interpretation (100% vs 38%, P = .025), which did not reach significance at blinded interpretation (88% vs 63%, P = .31). However, multivariable logistic regression analysis showed stress cardiac MR imaging to be the strongest independent predictor of significant CAD (P = .002). Conclusion:In patients presenting to the emergency department with intermediate-risk CP, adenosine stress cardiac MR imaging performed within 12 hours of presentation is safe and potentially has improved performance characteristics compared with stress echocardiography.q RSNA, 2013

Cardiovascular magnetic resonance accurately detects obstructive coronary artery disease in suspected non-ST elevation myocardial infarction: a sub-analysis of the CARMENTA Trial

“…Few studies have investigated the usefulness of comprehensive CMR imaging in patients with acute chest pain and suspected NSTEMI [22][23][24][25][26][27][28]. Although these studies cannot be compared directly because of differences in study population, design, prevalence of NSTEMI, CMR protocol and outcome measures, they all share a high sensitivity (up to 92%) and specificity (up to 96%).…”

Usefulness of cardiac MRI in the prognosis and follow-up of ischemic heart disease

“…67 CMR with adenosine has also been useful to stage risk in patients with acute chest pain in the ER. 68 In patients with a negative stress test, the free of episodes-survival rate after a year of follow-up was significantly greater if there was a perfusion defect in the CMR---adenosine. Therefore, in patients with suspicion of coronary artery disease or known coronary disease, the fact of not finding myocardial ischemia with CMR---dobutamine or vasodilating drugs is a sign of good prognosis.…”

Cardiovascular magnetic resonance: Stressing the future

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