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CARDIAC IMAGING

Assessment of non–ST-segment elevation acute coronary syndromes with cardiac magnetic resonance imaging

Sven Plein, MD^*,*, John P. Greenwood, PhD^*, John P. Ridgway, PhD, Gillian Cranny, MSc, Stephen G. Ball, PhD and Mohan U. Sivananthan, MD^*

BHF-Cardiac Magnetic Resonance Unit, the General Infirmary at Leeds, Leeds, United Kingdom
Department of Medical Physics, the General Infirmary at Leeds, Leeds, United Kingdom
Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
BHF Heart Research Centre, University of Leeds, Leeds, United Kingdom

Manuscript received March 22, 2004; revised manuscript received July 19, 2004, accepted August 10, 2004.

^* Reprint requests and correspondence: Dr. Sven Plein, BHF Cardiac Magnetic Resonance Unit, Room 170, D-floor, Jubilee Building, the General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, United Kingdom (Email: sven.plein{at}leedsth.nhs.uk).

OBJECTIVES: The goal of this study was to determine: 1) if the presence of significant coronary stenosis in patients presenting with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) can be predicted by cardiac magnetic resonance (CMR) imaging; and 2) if the analysis of several CMR methods improves its diagnostic yield compared with analysis of individual methods.

BACKGROUND: With modern acquisition techniques, several CMR methods for the assessment of coronary artery disease (CAD) can be combined in a single noninvasive scanning session. Such a multicomponent CMR examination has not previously been applied to a large patient population, in particular those with a high prevalence of CAD in an acute situation.

METHODS: Sixty-eight patients presenting with NSTE-ACS underwent CMR imaging of myocardial function, perfusion (rest and adenosine-stress), viability (by late contrast enhancement), and coronary artery anatomy. Visual analysis of CMR was carried out. First, all CMR data were reviewed in combination ("comprehensive analysis"). In further separate analyses, each CMR method was analyzed individually. The ability of CMR to detect coronary stenosis 70% on X-ray angiography was determined.

RESULTS: Comprehensive CMR analysis yielded a sensitivity of 96% and a specificity of 83% to predict the presence of significant coronary stenosis and was more accurate than analysis of any individual CMR method; CMR was significantly more sensitive and accurate than the Thrombolysis In Myocardial Infarction risk score (p < 0.001).

CONCLUSIONS: Cardiac magnetic resonance imaging accurately predicts the presence of significant CAD in patients with NSTE-ACS. In this study, a comprehensive analysis of several CMR methods improved the accuracy of the test.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CAD = coronary artery disease   CMR = cardiac magnetic resonance   LAD = left anterior descending artery   LCX = left circumflex coronary artery   NSTE-ACS = non–ST-segment elevation acute coronary syndrome   RCA = right coronary artery

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