CLINICAL RESEARCH: CARDIAC IMAGING
Improved Detection of Coronary Artery Disease by Stress Perfusion Cardiovascular Magnetic Resonance With the Use of Delayed Enhancement Infarction Imaging
Igor Klem, MD*, ,
John F. Heitner, MD*,
Dipan J. Shah, MD*,
Michael H. Sketch, Jr, MD*,
Victor Behar, MD*,
Jonathan Weinsaft, MD*,
Peter Cawley, MD*,
Michele Parker, RN, MS*,
Michael Elliott, MD*,
Robert M. Judd, PhD* and
Raymond J. Kim, MD*,*
* Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina
Robert-Bosch-Krankenhaus, Stuttgart, Germany
Manuscript received May 30, 2005;
revised manuscript received October 26, 2005,
accepted October 31, 2005.
* Reprint requests and correspondence: Dr. Raymond J. Kim, Duke Cardiovascular MRI Center, DUMC-3934, Durham, North Carolina 27710. (Email: Raymond.Kim{at}dcmrc.mc.duke.edu).
OBJECTIVES: We tested a pre-defined visual interpretation algorithm that combines cardiovascular magnetic resonance (CMR) data from perfusion and infarction imaging for the diagnosis of coronary artery disease (CAD).
BACKGROUND: Cardiovascular magnetic resonance can assess both myocardial perfusion and infarction with independent techniques in a single session.
METHODS: We prospectively enrolled 100 consecutive patients with suspected CAD scheduled for X-ray coronary angiography. Patients had comprehensive clinical evaluation, including Rose angina questionnaire, 12-lead electrocardiography, C-reactive protein, and calculation of Framingham risk. Cardiovascular magnetic resonance included cine, adenosine-stress and rest perfusion-CMR, and delayed enhancement-CMR (DE-CMR) for infarction imaging. Matched stress-rest perfusion defects in the absence of infarction by DE-CMR were considered artifactual. All patients underwent X-ray angiography within 24 h of CMR.
RESULTS: Ninety-two patients had complete CMR examinations. Significant CAD ( 70% stenosis) was found in 37 patients (40%). The combination of perfusion and DE-CMR had a sensitivity, specificity, and accuracy of 89%, 87%, and 88%, respectively, for CAD diagnosis, compared with 84%, 58%, and 68%, respectively, for perfusion-CMR alone. The combination had higher specificity and accuracy (p < 0.0001), owing to incorporating the exceptionally high specificity (98%) of DE-CMR. Receiver operating characteristic curve analysis demonstrated the combination provided better performance than cine, perfusion, or DE-CMR alone. The accuracy was high in single-vessel and multivessel disease and independent of CAD location. Multivariable analysis including standard clinical parameters demonstrated the combination was the strongest independent CAD predictor.
CONCLUSIONS: 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.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CMR = cardiovascular magnetic resonance imaging | | DE-CMR = delayed enhancement-cardiovascular magnetic resonance imaging | | hsCRP = high-sensitivity C-reactive protein | | LAD = left anterior descending coronary artery | | LCx = left circumflex coronary artery | | LV = left ventricle/ventricular | | MI = myocardial infarction | | RCA = right coronary artery | | ROC = receiver operating characteristic | | SPECT = single-photon emission computed tomography |
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