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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.

View larger version (68K): [in a new window]   Figure 1 Examples of abnormal adenosine cardiac magnetic resonance studies demonstrate the ability to detect ischemia in the absence of infarction and peri-infarct ischemia. The top row shows results from a 67-year-old female with no prior coronary artery disease (CAD), no evidence of myocardial infarction (MI), and an inferoseptal to inferolateral perfusion defect (arrows). The bottom row summarizes results from a 56-year-old female with a history of coronary artery bypass graft surgery (h/o CABG), silent micro-inferior myocardial infarction (MI) (black arrow), and a more extensive inferior to inferolateral perfusion defect (white arrows). Both patients had significant coronary stenoses and required revascularization. DE = delayed enhancement; Perf = perfusion.

View larger version (29K): [in a new window]   Figure 2 Kaplan-Meier survival distributions based on presence or absence of any abnormalities on the cardiac magnetic resonance (CMR) and 3 versus >3 total cardiac risk factors (TLCRF). Although the separation is statistically significant for each curve, note that a normal adenosine perfusion has 100% event-free survival (100% negative predictive value) whereas 35% of subjects with 3 TLCRF missed 35% of patients with an outcome dropping event-free survival in that group. CAD = coronary artery disease.

View larger version (22K): [in a new window]   Figure 3 Estimated receiver operating characteristic curve for total number of cardiac risk factors (TLCRF) (triangles) and receiver operating characteristic curve for total number of abnormalities on adenosine cardiac magnetic resonance (TLCMR) as a predictors of adverse cardiac outcome (circles).