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CLINICAL RESEARCH: CARDIAC IMAGING

Prognosis of Negative Adenosine Stress Magnetic Resonance in Patients Presenting to an Emergency Department With Chest Pain

W. Patricia Ingkanisorn, MD^_*, Raymond Y. Kwong, MD^_*, Nicole S. Bohme, BA, Nancy L. Geller, PhD, Kenneth L. Rhoads, MD^_*, Christopher K. Dyke, MD^_*, D. Ian Paterson, MD^_*, Mushabbar A. Syed, MD^_*, Anthony H. Aletras, PhD^_* and Andrew E. Arai, MD^_*,_*

^_* Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, and Suburban Hospital, Bethesda, Maryland
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

Manuscript received August 7, 2005; revised manuscript received October 25, 2005, accepted November 21, 2005.

^_* Reprint requests and correspondence: Dr. Andrew E. Arai, Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room BID416, MSC 1061, 10 Center Drive, Bethesda, Maryland 20892-1061. (Email: araia{at}nih.gov).

OBJECTIVES: This study was designed to determine the diagnostic value of adenosine cardiac magnetic resonance (CMR) in troponin-negative patients with chest pain.

BACKGROUND: We hypothesized that adenosine CMR could determine which troponin-negative patients with chest pain in an emergency department have coronary artery disease (CAD) or future adverse cardiac events.

METHODS: Adenosine stress CMR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction (MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as coronary artery stenosis >50% on angiography, abnormal correlative stress test, new MI, or death.

RESULTS: Adenosine perfusion abnormalities had 100% sensitivity and 93% specificity as the single most accurate component of the CMR examination. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis (log-rank test, p = 0.0006 and p < 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosine CMR was a more accurate predictor than cardiac risk factors (p < 0.002).

CONCLUSIONS: In patients with chest pain who had MI excluded by troponin-I and non-diagnostic electrocardiograms, an adenosine CMR examination predicted with high sensitivity and specificity which patients had significant CAD during one-year follow-up. Furthermore, no patients with a normal adenosine CMR study had a subsequent diagnosis of CAD or an adverse outcome.

Abbreviations and Acronyms   CAD = coronary artery disease   CMR = cardiac magnetic resonance   ECG = electrocardiogram   MI = myocardial infarction   TLCMR = total number of cardiac magnetic resonance abnormalities   TLCRF = total number of cardiac risk factors

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