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Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, Mantini C, Zimarino M, Fedorowski A, Gallina S, Petersen SE, Bucciarelli-Ducci C. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:662-673. [PMID: 37285143 PMCID: PMC10248816 DOI: 10.1001/jamacardio.2023.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Importance The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. Data Sources PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Study Selection Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. Data Extraction and Synthesis This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Main Outcomes and Measures Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. Results A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. Conclusion and Relevance In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Rimini Hospital, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Steffen E. Petersen
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
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Gaine SP, Sharma G, Tower-Rader A, Botros M, Kovell L, Parakh A, Wood MJ, Harrington CM. Multimodality Imaging in the Detection of Ischemic Heart Disease in Women. J Cardiovasc Dev Dis 2022; 9:350. [PMID: 36286302 PMCID: PMC9604786 DOI: 10.3390/jcdd9100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Women with coronary artery disease tend to have a worse short and long-term prognosis relative to men and the incidence of atherosclerotic cardiovascular disease is increasing. Women are less likely to present with classic anginal symptoms when compared with men and more likely to be misdiagnosed. Several non-invasive imaging modalities are available for diagnosing ischemic heart disease in women and many of these modalities can also assist with prognostication and help to guide management. Selection of the optimal imaging modality to evaluate women with possible ischemic heart disease is a scenario which clinicians often encounter. Earlier modalities such as exercise treadmill testing demonstrate significant performance variation in men and women, while newer modalities such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging are highly specific and sensitive for the detection of ischemia and coronary artery disease with greater parity between sexes. Individual factors, availability, diagnostic performance, and female-specific considerations such as pregnancy status may influence the decision to select one modality over another. Emerging techniques such as strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging present additional options for diagnosing ischemia and coronary microvascular dysfunction.
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Affiliation(s)
- Sean Paul Gaine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Albree Tower-Rader
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Mina Botros
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Lara Kovell
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Malissa J. Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Colleen M. Harrington
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
- Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA 02214, USA
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Arai AE, Schulz-Menger J, Berman D, Mahrholdt H, Han Y, Bandettini WP, Gutberlet M, Abraham A, Woodard PK, Selvanayagam JB, McCann GP, Hamilton-Craig C, Schoepf UJ, San Tan R, Kramer CM, Friedrich MG, Haverstock D, Liu Z, Brueggenwerth G, Bacher-Stier C, Santiuste M, Pennell DJ, Pennell D, Schulz-Menger J, Mahrholdt H, Gutberlet M, Kramer U, von der Recke G, Nassenstein K, Tillmanns C, Taupitz M, Pache G, Mohrs O, Lotz J, Ko SM, Choo KS, Sung YM, Kang JW, Muzzarelli S, Valeti U, McCann G, Binukrishnam S, Croisille P, Jacquier A, Cowan B, Arai A, Berman D, Shah D, Bandettini WP, Han Y, Woodard P, Avery R, Schoepf J, Carr J, Kramer C, Flamm S, Harsinghani M, Lerakis S, Kim R, Raman S, Marcotte F, Islam A, Friedrich M, Abraham A, Selvanayagam J, Hamilton-Craig C, Chong WK, San Lynette Teo L, San Tan R. Gadobutrol-Enhanced Cardiac Magnetic Resonance Imaging for Detection of Coronary Artery Disease. J Am Coll Cardiol 2020; 76:1536-1547. [DOI: 10.1016/j.jacc.2020.07.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022]
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Ferdinand KC, Samson R. Nonobstructive Coronary Artery Disease in Women: Risk Factors and Noninvasive Diagnostic Assessment. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hamada S, Gotschy A, Wissmann L, Paetsch I, Jahnke C, Plein S, Gebker R, Oebel S, Alkadhi H, Marx N, Lüscher TF, Kozerke S, Manka R. Multi-centre study of whole-heart dynamic 3D cardiac magnetic resonance perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve: gender based analysis of diagnostic performance. Eur Heart J Cardiovasc Imaging 2018; 18:1099-1106. [PMID: 28984890 DOI: 10.1093/ehjci/jex160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/19/2017] [Indexed: 11/15/2022] Open
Abstract
Aims Coronary artery disease (CAD) is a leading cause of morbidity and mortality in women and non-invasive testing for CAD in women can be more challenging than in men. This study compared the diagnostic performance of whole-heart dynamic 3D cardiovascular magnetic resonance (CMR) stress perfusion imaging in female and male patients with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as reference tests. Methods and results Four hundred sixteen patients with suspected or known CAD were enrolled in five European centres. CMR imaging was performed prior to clinically indicated coronary angiography. QCA was performed in all patients and FFR in 357 of 416 patients. Whole-heart dynamic 3D CMR first-pass perfusion imaging was conducted at rest and during adenosine stress. All CMR analyses were operated by experienced investigators blinded to all clinical data. One hundred nineteen female and 297 male patients were included and successfully examined (mean age 65 ± 11 and 63 ± 11 years, respectively). FFR was performed in 106 female and 251 male patients. Sensitivity and specificity of whole-heart dynamic 3D CMR stress perfusion imaging were 89% (95% CI: 77-96) and 82% (95% CI: 70-90) in the female population and 83% (95% CI: 77-86) and 79% (95% CI: 71-86) in the male population relative to QCA (P = 0.474 and P = 0.83, P-values for comparison between genders). Sensitivity and specificity were 95% (95% CI: 82-99) and 84% (95% CI: 73-92) in the female population and 83% (95% CI: 76-89) and 82% (95% CI: 74-88) in the male population when using FFR as the reference (P = 0.134 and P = 0.936, P-values for comparison between genders). Diagnostic accuracy in females was 92% (95% CI: 85-96) and 86% (95% CI: 81-90) in males when using FFR as the reference. The prevalence of CAD as defined by FFR (<0.8) was 36% in females and 53% in males. Conclusion Whole-heart dynamic 3D CMR stress perfusion imaging has a high diagnostic accuracy for the detection of significant CAD irrespective of gender and is therefore a suitable non-invasive testing tool to detect myocardial ischaemia in both genders.
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Affiliation(s)
- Sandra Hamada
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.,Department of Cardiology, Pneumology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland.,Division of Internal Medicine, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland
| | - Ingo Paetsch
- HELIOS Heart Center Leipzig - University Hospital of Leipzig, Department of Rhythmology, Struempellstrasse 39, Leipzig 04289, Germany
| | - Cosima Jahnke
- HELIOS Heart Center Leipzig - University Hospital of Leipzig, Department of Rhythmology, Struempellstrasse 39, Leipzig 04289, Germany
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Center & the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS29JT, UK
| | - Rolf Gebker
- German Heart Institute Berlin, Department of Internal Medicine - Cardiology, Augustenburger Platz 1, Berlin 13353, Germany
| | - Sabrina Oebel
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Nikolaus Marx
- Department of Cardiology, Pneumology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland
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Masuda A, Nemoto A, Takeishi Y. Technical aspects of cardiac PET/MRI. J Nucl Cardiol 2018; 25:1023-1028. [PMID: 29468469 DOI: 10.1007/s12350-018-1237-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/24/2018] [Indexed: 11/24/2022]
Abstract
PET/MRI is a novel modality that enables to combine PET and MR images, and has significant potential to evaluate various cardiac diseases through the combination of PET molecular imaging and MRI functional imaging. Precise management of technical issues, however, is necessary for cardiac PET/MRI. This article describes several technical points, including patient preparation, MR attenuation correction, parallel acquisition of PET with MRI, clinical aspects, and image quality control.
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Affiliation(s)
- Atsuro Masuda
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295, Japan.
| | - Ayaka Nemoto
- Advanced Clinical Research Center, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295, Japan
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Liu JM, Liu A, Leal J, McMillan F, Francis J, Greiser A, Rider OJ, Myerson S, Neubauer S, Ferreira VM, Piechnik SK. Measurement of myocardial native T1 in cardiovascular diseases and norm in 1291 subjects. J Cardiovasc Magn Reson 2017; 19:74. [PMID: 28954631 PMCID: PMC5618724 DOI: 10.1186/s12968-017-0386-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/05/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Native T1-mapping provides quantitative myocardial tissue characterization for cardiovascular diseases (CVD), without the need for gadolinium. However, its translation into clinical practice is hindered by differences between techniques and the lack of established reference values. We provide typical myocardial T1-ranges for 18 commonly encountered CVDs using a single T1-mapping technique - Shortened Look-Locker Inversion Recovery (ShMOLLI), also used in the large UK Biobank and Hypertrophic Cardiomyopathy Registry study. METHODS We analyzed 1291 subjects who underwent CMR (1.5-Tesla, MAGNETOM-Avanto, Siemens Healthcare, Erlangen, Germany) between 2009 and 2016, who had a single CVD diagnosis, with mid-ventricular T1-map assessment. A region of interest (ROI) was placed on native T1-maps in the "most-affected myocardium", characterized by the presence of late gadolinium enhancement (LGE), or regional wall motion abnormalities (RWMA) on cines. Another ROI was placed in the "reference myocardium" as far as possible from LGE/RWMA, and in the septum if no focal abnormality was present. To further define normality, we included native T1 of healthy subjects from an existing dataset after sub-endocardial pixel-erosions. RESULTS Native T1 of patients with normal CMR (938 ± 21 ms) was similar compared to healthy subjects (941 ± 23 ms). Across all patient groups (57 ± 19 yrs., 65% males), focally affected myocardium had significantly different T1 value compared to reference myocardium (all p < 0.001). In the affected myocardium, cardiac amyloidosis (1119 ± 61 ms) had the highest native T1 compared to normal and all other CVDs, while iron-overload (795 ± 58 ms) and Anderson-Fabry disease (863 ± 23 ms) had the lowest native reference T1 (all p < 0.001). Future studies designed to detect the large T1 differences between affected and reference myocardium are estimated to require small sample-sizes (n < 50). However, studies designed to detect the small T1 differences between reference myocardium in CVDs and healthy controls can require several thousand of subjects. CONCLUSIONS We provide typical T1-ranges for common clinical cardiac conditions in the largest cohort to-date, using ShMOLLI T1-mapping at 1.5 T. Sample-size calculations from this study may be useful for the design of future studies and trials that use T1-mapping as an endpoint.
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Affiliation(s)
- Joanna M. Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Joana Leal
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Fiona McMillan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Jane Francis
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | | | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Saul Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
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Le TT, Huang W, Bryant JA, Cook SA, Chin CWL. Stress cardiovascular magnetic resonance imaging: current and future perspectives. Expert Rev Cardiovasc Ther 2017; 15:181-189. [DOI: 10.1080/14779072.2017.1296356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Thu-Thao Le
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Weiting Huang
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart Alexander Cook
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Calvin Woon-Loong Chin
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Fractal analysis of the ischemic transition region in chronic ischemic heart disease using magnetic resonance imaging. Eur Radiol 2016; 27:1537-1546. [PMID: 27436024 DOI: 10.1007/s00330-016-4492-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/01/2016] [Accepted: 06/27/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To introduce a novel hypothesis and method to characterise pathomechanisms underlying myocardial ischemia in chronic ischemic heart disease by local fractal analysis (FA) of the ischemic myocardial transition region in perfusion imaging. METHODS Vascular mechanisms to compensate ischemia are regulated at various vascular scales with their superimposed perfusion pattern being hypothetically self-similar. Dedicated FA software ("FraktalWandler") has been developed. Fractal dimensions during first-pass (FDfirst-pass) and recirculation (FDrecirculation) are hypothesised to indicate the predominating pathomechanism and ischemic severity, respectively. RESULTS Twenty-six patients with evidence of myocardial ischemia in 108 ischemic myocardial segments on magnetic resonance imaging (MRI) were analysed. The 40th and 60th percentiles of FDfirst-pass were used for pathomechanical classification, assigning lesions with FDfirst-pass ≤ 2.335 to predominating coronary microvascular dysfunction (CMD) and ≥2.387 to predominating coronary artery disease (CAD). Optimal classification point in ROC analysis was FDfirst-pass = 2.358. FDrecirculation correlated moderately with per cent diameter stenosis in invasive coronary angiography in lesions classified CAD (r = 0.472, p = 0.001) but not CMD (r = 0.082, p = 0.600). CONCLUSIONS The ischemic transition region may provide information on pathomechanical composition and severity of myocardial ischemia. FA of this region is feasible and may improve diagnosis compared to traditional noninvasive myocardial perfusion analysis. KEY POINTS • A novel hypothesis and method is introduced to pathophysiologically characterise myocardial ischemia. • The ischemic transition region appears a meaningful diagnostic target in perfusion imaging. • Fractal analysis may characterise pathomechanical composition and severity of myocardial ischemia.
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Ahmad IG, Abdulla RK, Klem I, Margulis R, Ivanov A, Mohamed A, Judd RM, Borges-Neto S, Kim RJ, Heitner JF. Comparison of stress cardiovascular magnetic resonance imaging (CMR) with stress nuclear perfusion for the diagnosis of coronary artery disease. J Nucl Cardiol 2016; 23:287-97. [PMID: 26268824 DOI: 10.1007/s12350-015-0242-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 06/16/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To assess the diagnostic performance of stress cardiac magnetic resonance (stress CMR) vs stress single-photon emission computed tomography (SPECT) in patients presenting to the emergency department (ED) with chest pain. BACKGROUND SPECT imaging is the most utilized outpatient procedure in the United States. The diagnostic accuracy of SPECT can be limited by soft tissue attenuation and low spatial resolution. Stress CMR has much higher spatial resolution and without the susceptibility to soft tissue attenuation. METHODS Eighty-seven patients without a history of CAD presenting to the ED with chest pain were prospectively enrolled. Patients underwent both stress CMR and stress SPECT imaging within 12 hours of presentation. Both the stress imaging tests were interpreted immediately for clinical purposes and coronary angiography was performed if either was abnormal. Patients were considered to have significant CAD if identified by angiography (≥50%) or if a cardiac event (cardiac death, myocardial infarction or revascularization) occurred during follow-up (mean 2.6 ± 1.1 years). RESULTS Thirty-seven patients were referred for coronary angiography; 29 due to a positive stress test and eight patients for persistent chest pain despite two negative stress tests. There were 22 patients who had significant CAD (≥50%). The remaining patients were followed for 2.6 ± 1.1 years. At the conclusion of the follow-up period, there were four clinical events. The sensitivity, specificity, and diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%, 91%, and 88%, respectively. CONCLUSION Stress CMR has similar diagnostic accuracy as stress SPECT in diagnosis of CAD.
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Affiliation(s)
- Ijaz G Ahmad
- Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA
| | - Raushan K Abdulla
- Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Roman Margulis
- Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA
| | - Alexander Ivanov
- Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA
| | - Ambreen Mohamed
- Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA
| | - Robert M Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - John F Heitner
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA.
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.
- Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA.
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Baldassarre LA, Raman SV, Min JK, Mieres JH, Gulati M, Wenger NK, Marwick TH, Bucciarelli-Ducci C, Bairey Merz CN, Itchhaporia D, Ferdinand KC, Pepine CJ, Walsh MN, Narula J, Shaw LJ. Noninvasive Imaging to Evaluate Women With Stable Ischemic Heart Disease. JACC Cardiovasc Imaging 2016; 9:421-35. [PMID: 27056162 PMCID: PMC5486953 DOI: 10.1016/j.jcmg.2016.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 12/18/2022]
Abstract
Declines in cardiovascular deaths have been dramatic for men but occur significantly less in women. Among patients with symptomatic ischemic heart disease (IHD), women experience relatively worse outcomes compared with their male counterparts. Evidence to date has failed to adequately explore unique female imaging targets and their correlative signs and symptoms of IHD as major determinants of IHD risk. We highlight sex-specific anatomic and functional differences in contemporary imaging and introduce imaging approaches that leverage refined targets that may improve IHD risk prediction and identify potential therapeutic strategies for symptomatic women.
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Affiliation(s)
| | - Subha V Raman
- The Ohio State University College of Medicine, Columbus, Ohio
| | - James K Min
- Weill Cornell Medical College, New York, New York
| | | | - Martha Gulati
- The University of Arizona College of Medicine, Tucson, Arizona
| | | | | | | | | | - Dipti Itchhaporia
- Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, California
| | | | - Carl J Pepine
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia.
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12
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Greulich S, Steubing H, Birkmeier S, Grün S, Bentz K, Sechtem U, Mahrholdt H. Impact of arrhythmia on diagnostic performance of adenosine stress CMR in patients with suspected or known coronary artery disease. J Cardiovasc Magn Reson 2015; 17:94. [PMID: 26541808 PMCID: PMC4635579 DOI: 10.1186/s12968-015-0195-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/21/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The diagnostic performance of adenosine stress cardiovascular magnetic resonance (CMR) in patients with arrhythmias presenting for work-up of suspected or known CAD is largely unknown, since most CMR studies currently available exclude arrhythmic patients from analysis fearing gating problems, or other artifacts will impair image quality. The primary aim of our study was to evaluate the diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for 1) work-up of suspected coronary artery disease (CAD), or 2) work-up of ischemia in known CAD. METHODS Patients with arrhythmia referred for work-up of suspected CAD or work-up of ischemia in known CAD undergoing adenosine stress CMR were included if they had coronary angiography within four weeks of CMR. RESULTS One hundred fifty-nine patients were included (n = 64 atrial fibrillation, n = 87 frequent ventricular extrasystoles, n = 8 frequent supraventricular extrasystoles). Of these, n = 72 had suspected CAD, and n = 87 had known CAD. Diagnostic accuracy of the adenosine stress CMR for detection of significant CAD was 73 % for the entire population (sensitivity 72 %, specificity 76 %). Diagnostic accuracy was 75 % (sensitivity 80 %, specificity 74 %) in patients with suspected CAD, and 74 % (sensitivity 71 %, specificity 79 %) in the group with known CAD. For different types of arrhythmia, diagnostic accuracy of CMR was 70 % in the atrial fibrillation group, and 79 % in patients with ventricular extrasystoles. On a per coronary territory analysis, diagnostic accuracy of CMR was 77 % for stenosis of the left and 82 % for stenosis of the right coronary artery. CONCLUSION The present data demonstrates good diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for work-up of suspected CAD, or work-up of ischemia in known CAD. This holds true for a per patient, as well as for a per coronary territory analysis.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Hannah Steubing
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Stefan Birkmeier
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Stefan Grün
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Kerstin Bentz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
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13
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Measuring myocardial perfusion: the role of PET, MRI and CT. Clin Radiol 2015; 70:576-84. [DOI: 10.1016/j.crad.2014.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 02/08/2023]
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14
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Ko SM, Hwang HK, Kim SM, Cho IH. Multi-modality imaging for the assessment of myocardial perfusion with emphasis on stress perfusion CT and MR imaging. Int J Cardiovasc Imaging 2015; 31 Suppl 1:1-21. [PMID: 25809387 DOI: 10.1007/s10554-015-0645-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/16/2015] [Indexed: 01/29/2023]
Abstract
High-quality and non-invasive diagnostic tools for assessing myocardial ischemia are necessary for therapeutic decisions regarding coronary artery disease. Myocardial perfusion has been studied using myocardial contrast echo perfusion, single-photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and, more recently, computed tomography. The addition of coronary computed tomography angiography to myocardial perfusion imaging improves the specificity and overall diagnostic accuracy of detecting the hemodynamic significance of coronary artery stenosis. This study reviews the benefits, limitations, and imaging findings of various imaging modalities for assessing myocardial perfusion, with particular emphasis on stress perfusion computed tomography and cardiovascular magnetic resonance imaging.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea,
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15
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Becker M, Hundemer A, Zwicker C, Altiok E, Krohn T, Mottaghy FM, Lente C, Kelm M, Marx N, Hoffmann R. Detection of coronary artery disease in postmenopausal women: the significance of integrated stress imaging tests in a 4-year prognostic study. Clin Res Cardiol 2014; 104:258-71. [PMID: 25367244 DOI: 10.1007/s00392-014-0780-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The present prospective study investigated whether a combined approach integrating two different stress imaging modalities may improve the diagnostic accuracy and prognostic impact of non-invasive coronary artery disease (CAD) tests in postmenopausal women. In women non-invasive tests for detecting CAD are less accurate than in men, leading to a high proportion of unnecessary coronary angiographies (CAs). METHODS 424 consecutive postmenopausal women (mean 61 ± 7 years, mean Reynolds Risk Score 13 ± 3 %) with symptoms suggestive of CAD were prospectively included and followed up for 4 ± 1 years. Each patient underwent CA, stress cardiovascular magnetic resonance (CMR) by adenosine, dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) within 7 ± 3 days. RESULTS Anatomically obstructive coronary artery disease (≥50 % diameter stenosis) was present in 157 women (37 %). The combination of two stress imaging modalities significantly increased the positive predictive values (PPV) to 90 ± 3, 88 ± 3 and 87 ± 2 % for CMR/DSE, DSE/SPECT and CMR/SPECT, respectively. For patients with negative combined test results, the survival analysis showed a 4-year cumulative event-free survival rate of 96-97 % for all combinations. This new approach is cost effective due to the resulting reduction in unnecessary CAs (with potential side effects and corresponding therapies) as well as reducing hospitalization time. CONCLUSIONS In symptomatic postmenopausal women, combination of two negative stress imaging results significantly increases the PPV for detection of CAD and excludes future cardiovascular events with high accuracy. This approach may be applied to improve the prognostic precision of non-invasive CAD tests and to avoid unnecessary CAs.
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Affiliation(s)
- Michael Becker
- Department of Cardiology, RWTH Aachen University, Aachen, Germany,
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16
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Mieres JH, Gulati M, Bairey Merz N, Berman DS, Gerber TC, Hayes SN, Kramer CM, Min JK, Newby LK, Nixon JVI, Srichai MB, Pellikka PA, Redberg RF, Wenger NK, Shaw LJ. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130:350-79. [PMID: 25047587 DOI: 10.1161/cir.0000000000000061] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Greenwood JP, Motwani M, Maredia N, Brown JM, Everett CC, Nixon J, Bijsterveld P, Dickinson CJ, Ball SG, Plein S. Comparison of cardiovascular magnetic resonance and single-photon emission computed tomography in women with suspected coronary artery disease from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) Trial. Circulation 2013; 129:1129-38. [PMID: 24357404 DOI: 10.1161/circulationaha.112.000071] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in women, and underdiagnosis contributes to the high mortality. This study compared the sex-specific diagnostic performance of cardiovascular magnetic resonance (CMR) and single-photon emission computed tomography (SPECT). METHODS AND RESULTS A total of 235 women and 393 men with suspected angina underwent CMR, SPECT, and x-ray angiography as part of the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) study. CMR comprised adenosine stress/rest perfusion, cine imaging, late gadolinium enhancement, and magnetic resonance coronary angiography. Gated adenosine stress/rest SPECT was performed with (99m)Tc-tetrofosmin. For CMR, the sensitivity in women and men was similar (88.7% versus 85.6%; P=0.57), as was the specificity (83.5% versus 82.8%; P=0.86). For SPECT, the sensitivity was significantly worse in women than in men (50.9% versus 70.8%; P=0.007), but the specificities were similar (84.1% versus 81.3%; P=0.48). The sensitivity in both the female and male groups was significantly higher with CMR than SPECT (P<0.0001 for both), but the specificity was similar (P=0.77 and P=1.00, respectively). For perfusion-only components, CMR outperformed SPECT in women (area under the curve, 0.90 versus 0.67; P<0.0001) and in men (area under the curve, 0.89 versus 0.74; P<0.0001). Diagnostic accuracy was similar in both sexes with perfusion CMR (P=1.00) but was significantly worse in women with SPECT (P<0.0001). CONCLUSIONS In both sexes, CMR has greater sensitivity than SPECT. Unlike SPECT, there are no significant sex differences in the diagnostic performance of CMR. These findings, plus an absence of ionizing radiation exposure, mean that CMR should be more widely adopted in women with suspected coronary artery disease. CLINICAL TRIAL REGISTRATION URL http://www.controlled-trials.com. Unique identifier: ISRCTN77246133.
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Affiliation(s)
- John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics (J.P.G., M.M., N.M., P.B., S.G.B., S.P.) and Clinical Trials Research Unit (J.M.B., C.C.E., J.N.), University of Leeds, Leeds, UK; and Department of Nuclear Cardiology, Leeds General Infirmary, Leeds, UK (C.J.D.)
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18
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Heitner JF, Klem I, Rasheed D, Chandra A, Kim HW, Van Assche LMR, Parker M, Judd RM, Jollis JG, Kim RJ. 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. Radiology 2013; 271:56-64. [PMID: 24475814 DOI: 10.1148/radiol.13130557] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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 ± 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. Online supplemental material is available for this article.
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Affiliation(s)
- John F Heitner
- From the Duke Cardiovascular Magnetic Resonance Center (J.F.H., I.K., H.W.K., L.M.R.V.A., M.P., R.M.J., R.J.K.) and Departments of Medicine (J.F.H., I.K., D.R., H.W.K., L.M.R.V.A., M.P., R.M.J., J.G.J., R.J.K.), Emergency Medicine (A.C.), and Radiology (R.M.J., R.J.K.), Duke University Medical Center, Box 3934, Durham, NC 27710
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19
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Walker S, Girardin F, McKenna C, Ball SG, Nixon J, Plein S, Greenwood JP, Sculpher M. Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study. Heart 2013; 99:873-81. [PMID: 23591668 DOI: 10.1136/heartjnl-2013-303624] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of diagnostic strategies for coronary heart disease (CHD) derived from the CE-MARC study. DESIGN Cost-effectiveness analysis using a decision analytic model to compare eight strategies for the diagnosis of CHD. SETTING Secondary care out-patients (Cardiology Department). PATIENTS Patients referred to cardiologists for the further evaluation of symptoms thought to be angina pectoris. INTERVENTIONS Eight different strategies were considered, including different combinations of exercise treadmill testing (ETT), single-photon emission CT (SPECT), cardiovascular magnetic resonance (CMR) and coronary angiography (CA). MAIN OUTCOME MEASURES Costs expressed as UK sterling in 2010-2011 prices and health outcomes in quality-adjusted life-years (QALYs). The time horizon was 50 years. RESULTS Based on the characteristics of patients in the CE-MARC study, only two strategies appear potentially cost-effective for diagnosis of CHD, both including CMR. The choice is between two strategies: one in which CMR follows a positive or inconclusive ETT, followed by CA if CMR is positive or inconclusive (Strategy 3 in the model); and the other where CMR is followed by CA if CMR is positive or inconclusive (Strategy 5 in the model). The more cost-effective of these two rests on the threshold cost per QALY gained below which health systems define an intervention as cost-effective. Strategy 3 appears cost-effective at the lower end of the threshold range used in the UK (£20 000 per QALY gained), while Strategy 5 appears cost-effective at the higher end of the threshold range (£30 000 per QALY). The results are robust to various sources of uncertainty although prior likelihood of CHD requiring revascularisation and the rate at which false negative patients are eventually appropriately identified do impact upon the results. CONCLUSIONS The CE-MARC study showed that CMR had superior diagnostic accuracy to SPECT and concluded that CMR should be more widely used in the investigation of patients with CHD. The economic evaluation results show that using CMR is also a cost-effective strategy and supports the wider adoption of this modality.
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Affiliation(s)
- Simon Walker
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York YO10 5DD, UK.
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20
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Coelho-Filho OR, Rickers C, Kwong RY, Jerosch-Herold M. MR myocardial perfusion imaging. Radiology 2013; 266:701-15. [PMID: 23431226 DOI: 10.1148/radiol.12110918] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contrast material-enhanced myocardial perfusion imaging by using cardiac magnetic resonance (MR) imaging has, during the past decade, evolved into an accurate technique for diagnosing coronary artery disease, with excellent prognostic value. Advantages such as high spatial resolution; absence of ionizing radiation; and the ease of routine integration with an assessment of viability, wall motion, and cardiac anatomy are readily recognized. The need for training and technical expertise and the regulatory hurdles, which might prevent vendors from marketing cardiac MR perfusion imaging, may have hampered its progress. The current review considers both the technical developments and the clinical experience with cardiac MR perfusion imaging, which hopefully demonstrates that it has long passed the stage of a research technique. In fact, cardiac MR perfusion imaging is moving beyond traditional indications such as diagnosis of coronary disease to novel applications such as in congenital heart disease, where the imperatives of avoidance of ionizing radiation and achievement of high spatial resolution are of high priority. More wide use of cardiac MR perfusion imaging, and novel applications thereof, are aided by the progress in parallel imaging, high-field-strength cardiac MR imaging, and other technical advances discussed in this review.
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Affiliation(s)
- Otavio R Coelho-Filho
- Division of Cardiology and Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
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21
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Goykhman P, Mehta PK, Agarwal M, Shufelt C, Slomka PJ, Yang Y, Xu Y, Shaw LJ, Berman DS, Merz NB, Thomson LEJ. Reproducibility of myocardial perfusion reserve - variations in measurements from post processing using commercially available software. Cardiovasc Diagn Ther 2012; 2:268-77. [PMID: 24282727 PMCID: PMC3839165 DOI: 10.3978/j.issn.2223-3652.2012.10.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/11/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE Adenosine stress first pass cardiac magnetic resonance imaging (CMRI) is a rapidly evolving tool in the diagnosis of ischemic heart disease (IHD). The rest and stress first pass myocardial perfusion data may be interpreted using commercially available software for calculation of time intensity curves in order to generate a numeric value of the segmental or whole heart myocardial perfusion reserve index (MPRI). The objective of this study was to determine the inter- and intra-observer reliability of the data generated by standard commercially available software. METHODS Data from 20 adenosine stress CMRI (1.5 T) studies were analyzed using commercially available CAAS MRV 3.3 software (Pie Medical Imaging B.V., Netherlands) for calculation of the MPRI. The stress CMRI was performed using a standardized protocol in 20 women including 10 women with angina and the absence of obstructive CAD and 10 healthy volunteers. MPRI calculation was made in a standardized manner on separate occasions by two independent observers. A single observer repeated the calculation of MPRI three months later, without reference to the prior data. Basal, mid, and apical segments, for the whole myocardium, sub-endocardium, and sub-epicardium were analyzed. Intra-class correlation coefficients (ICC), repeatability coefficients (RC), and coefficients of variation (CoV) were determined. RESULTS The MPRI results by repeated software measurements were highly correlated, with potentially important variations in measurement observed. The myocardial inter-observer ICC was 0.80 (95% CI, 0.57, 0.92) with a CoV of 7.5%, and intra-observer ICC was 0.89 (95% CI, 0.77, 0.95) with a CoV of 3.6%. The mid-ventricular level MPRI was most reproducible, with intra-observer ICC at 0.91 (95% CI, 0.77, 0.97); intra-observer measurement was more reproducible than inter-observer measurement. CONCLUSIONS There is variation in measurement of MPRI observed in post processing of perfusion data when using a standardized approach and commercially available software. This has implications in the interpretation of data obtained for clinical and research purposes.
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Affiliation(s)
- Pavel Goykhman
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Puja K. Mehta
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Megha Agarwal
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Chrisandra Shufelt
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Piotr J. Slomka
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuching Yang
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Yuan Xu
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leslee J. Shaw
- Program in Cardiovascular Outcomes Research and Epidemiology, Emory University, Atlanta, GA, USA
| | - Daniel S. Berman
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Noel Bairey Merz
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Louise E. J. Thomson
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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22
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Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K, Schönberg SO, Debl K, Strohm O, Ahlstrom H, Dill T, Hoebel N, Simor T. Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial). J Cardiovasc Magn Reson 2012; 14:61. [PMID: 22938651 PMCID: PMC3443449 DOI: 10.1186/1532-429x-14-61] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/09/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Perfusion-cardiovascular magnetic resonance (CMR) is generally accepted as an alternative to SPECT to assess myocardial ischemia non-invasively. However its performance vs gated-SPECT and in sub-populations is not fully established. The goal was to compare in a multicenter setting the diagnostic performance of perfusion-CMR and gated-SPECT for the detection of CAD in various populations using conventional x-ray coronary angiography (CXA) as the standard of reference. METHODS In 33 centers (in US and Europe) 533 patients, eligible for CXA or SPECT, were enrolled in this multivendor trial. SPECT and CXA were performed within 4 weeks before or after CMR in all patients. Prevalence of CAD in the sample was 49% and 515 patients received MR contrast medium. Drop-out rates for CMR and SPECT were 5.6% and 3.7%, respectively (ns). The study was powered for the primary endpoint of non-inferiority of CMR vs SPECT for both, sensitivity and specificity for the detection of CAD (using a single-threshold reading), the results for the primary endpoint were reported elsewhere. In this article secondary endpoints are presented, i.e. the diagnostic performance of CMR versus SPECT in subpopulations such as multi-vessel disease (MVD), in men, in women, and in patients without prior myocardial infarction (MI). For diagnostic performance assessment the area under the receiver-operator-characteristics-curve (AUC) was calculated. Readers were blinded versus clinical data, CXA, and imaging results. RESULTS The diagnostic performance (= area under ROC = AUC) of CMR was superior to SPECT (p = 0.0004, n = 425) and to gated-SPECT (p = 0.018, n = 253). CMR performed better than SPECT in MVD (p = 0.003 vs all SPECT, p = 0.04 vs gated-SPECT), in men (p = 0.004, n = 313) and in women (p = 0.03, n = 112) as well as in the non-infarct patients (p = 0.005, n = 186 in 1-3 vessel disease and p = 0.015, n = 140 in MVD). CONCLUSION In this large multicenter, multivendor study the diagnostic performance of perfusion-CMR to detect CAD was superior to perfusion SPECT in the entire population and in sub-groups. Perfusion-CMR can be recommended as an alternative for SPECT imaging. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT00977093.
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Affiliation(s)
- Juerg Schwitter
- Cardiology, University Hospital Lausanne, Rue de Bugnon 46, CH-1011, Lausanne, Switzerland
| | | | - Norbert Wilke
- University of Florida Health Science Center, Gainesville/Jacksonville, USA
| | - Nidal Al-Saadi
- Franz-Volhard Clinic-Humboldt University, Berlin, Germany
| | | | | | - Stefan O Schönberg
- LMU Munich, Grosshadern, Germany
- current affiliation - University Medical Center Mannheim, Mannheim, Germany
| | - Kurt Debl
- University Hospital Regensburg, Regensburg, Germany
| | | | | | - Thorsten Dill
- Kerckhoff Clinics Bad Nauheim, Nauheim, Germany
- Current affiliation - Sana Kliniken Duesseldorf, Duesseldorf, Germany
| | - Nadja Hoebel
- GE Healthcare Buchler GmbH & Co.KG, Munich, Germany
| | - Tamas Simor
- Medical University of Science, Pecs, Hungary
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23
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Affiliation(s)
- Khaled Alfakih
- Cardiology Unit, Lewisham University Hospital, London, UK.
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24
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Greulich S, Bruder O, Parker M, Schumm J, Grün S, Schneider S, Klem I, Sechtem U, Mahrholdt H. Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women. J Cardiovasc Magn Reson 2012; 14:36. [PMID: 22697372 PMCID: PMC3411505 DOI: 10.1186/1532-429x-14-36] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed. METHODS AND RESULTS We prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA.Exercise ECG, CMR and CA was completed in 68 females (age 66.4 ± 8.8 years, number of CAD risk factors 3.5±1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was -3.0±5.4 and was similar in those with and without CAD (-4.5±5.8 and -2.4±5.1; P=0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P=0.02, specificities 94% and 73%, P=0.01, and accuracies 91% and 66%, P=0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94±0.03 vs 0.56±0.07; P=0.0001). CONCLUSIONS In women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.
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Affiliation(s)
- Simon Greulich
- Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Oliver Bruder
- Contilia Heart and Vascular Center, Elisabeth Hospital Essen, Essen, Germany
| | | | - Julia Schumm
- Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Stefan Grün
- Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Steffen Schneider
- Contilia Heart and Vascular Center, Elisabeth Hospital Essen, Essen, Germany
| | - Igor Klem
- Duke University Medical Center, Durham, NC, USA
| | - Udo Sechtem
- Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Heiko Mahrholdt
- Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
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Multicenter Studies on Cardiac Magnetic Resonance Perfusion and Delayed Enhancement Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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26
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Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, Bijsterveld P, Ridgway JP, Radjenovic A, Dickinson CJ, Ball SG, Plein S. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 2012; 379:453-60. [PMID: 22196944 PMCID: PMC3273722 DOI: 10.1016/s0140-6736(11)61335-4] [Citation(s) in RCA: 772] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND In patients with suspected coronary heart disease, single-photon emission computed tomography (SPECT) is the most widely used test for the assessment of myocardial ischaemia, but its diagnostic accuracy is reported to be variable and it exposes patients to ionising radiation. The aim of this study was to establish the diagnostic accuracy of a multiparametric cardiovascular magnetic resonance (CMR) protocol with x-ray coronary angiography as the reference standard, and to compare CMR with SPECT, in patients with suspected coronary heart disease. METHODS In this prospective trial patients with suspected angina pectoris and at least one cardiovascular risk factor were scheduled for CMR, SPECT, and invasive x-ray coronary angiography. CMR consisted of rest and adenosine stress perfusion, cine imaging, late gadolinium enhancement, and MR coronary angiography. Gated adenosine stress and rest SPECT used (99m)Tc tetrofosmin. The primary outcome was diagnostic accuracy of CMR. This trial is registered at controlled-trials.com, number ISRCTN77246133. FINDINGS In the 752 recruited patients, 39% had significant CHD as identified by x-ray angiography. For multiparametric CMR the sensitivity was 86·5% (95% CI 81·8-90·1), specificity 83·4% (79·5-86·7), positive predictive value 77·2%, (72·1-81·6) and negative predictive value 90·5% (87·1-93·0). The sensitivity of SPECT was 66·5% (95% CI 60·4-72·1), specificity 82·6% (78·5-86·1), positive predictive value 71·4% (65·3-76·9), and negative predictive value 79·1% (74·8-82·8). The sensitivity and negative predictive value of CMR and SPECT differed significantly (p<0·0001 for both) but specificity and positive predictive value did not (p=0·916 and p=0·061, respectively). INTERPRETATION CE-MARC is the largest, prospective, real world evaluation of CMR and has established CMR's high diagnostic accuracy in coronary heart disease and CMR's superiority over SPECT. It should be adopted more widely than at present for the investigation of coronary heart disease. FUNDING British Heart Foundation.
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Affiliation(s)
- John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK.
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27
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Coelho-Filho OR, Seabra LF, Mongeon FP, Abdullah SM, Francis SA, Blankstein R, Di Carli MF, Jerosch-Herold M, Kwong RY. Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex. JACC Cardiovasc Imaging 2011; 4:850-61. [PMID: 21835377 DOI: 10.1016/j.jcmg.2011.04.015] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/11/2011] [Accepted: 04/21/2011] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The major aim of this study is to test the hypothesis that stress cardiac magnetic resonance (CMR) imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. BACKGROUND Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men owing to a lack of early diagnosis and management. Numerous clinical studies have shown that stress CMR detects evidence of myocardial ischemia and infarction at high accuracy. Compared to nuclear scintigraphy, CMR is free of ionizing radiation, has high spatial resolution for imaging small hearts, and overcomes breast attenuation artifacts, which are substantial advantages when imaging women for CAD. METHODS We performed stress CMR in 405 patients (168 women, mean age 58 ± 14 years) referred for ischemia assessment. CMR techniques included cine cardiac function, perfusion imaging during vasodilating stress, and late gadolinium enhancement imaging. All patients were followed for major adverse cardiac events (MACE). RESULTS At a median follow-up of 30 months, MACE occurred in 36 patients (9%) including 21 cardiac deaths and 15 acute myocardial infarctions. In women, CMR evidence of ischemia (ISCHEMIA) demonstrated strong association with MACE (unadjusted hazard ratio: 49.9, p < 0.0001). While women with ISCHEMIA(+) had an annual MACE rate of 15%, women with ISCHEMIA(-) had very low annual MACE rate (0.3%), which was not statistically different from the low annual MACE rate in men with ISCHEMIA(-) (1.1%). CMR myocardial ischemia score was the strongest multivariable predictor of MACE in this cohort, for both women and men, indicating robust cardiac prognostication regardless of sex. CONCLUSIONS In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia.
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Affiliation(s)
- Otavio R Coelho-Filho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Heydari B, Jerosch-Herold M, Kwong RY. Assessment of myocardial ischemia with cardiovascular magnetic resonance. Prog Cardiovasc Dis 2011; 54:191-203. [PMID: 22014487 DOI: 10.1016/j.pcad.2011.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Assessment of myocardial ischemia in symptomatic patients remains a common and challenging clinical situation faced by physicians. Risk stratification by presence of ischemia provides important utility for both prognostic assessment and management. Unfortunately, current noninvasive modalities possess numerous limitations and have limited prognostic capacity. More recently, ischemia assessment by cardiovascular magnetic resonance (CMR) has been shown to be a safe, available, and potentially cost-effective alternative with both high diagnostic and prognostic accuracy. Cardiovascular magnetic resonance has numerous advantages over other noninvasive methods, including high temporal and spatial resolution, relatively few contraindications, and absence of ionizing radiation. Furthermore, studies assessing the clinical utility and cost effectiveness of CMR in the short-term setting for patients without evidence of an acute myocardial infarction have also demonstrated favorable results. This review will cover techniques of ischemia assessment with CMR by both stress-induced wall motion abnormalities as well as myocardial perfusion imaging. The diagnostic and prognostic performance studies will also be reviewed, and the use of CMR for ischemia assessment will be compared with other commonly used noninvasive modalities.
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Affiliation(s)
- Bobak Heydari
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA 02215, USA
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29
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Chotenimitkhun R, Hundley WG. Pharmacological stress cardiovascular magnetic resonance. Postgrad Med 2011; 123:162-70. [PMID: 21566427 DOI: 10.3810/pgm.2011.05.2295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the past decade, cardiovascular magnetic resonance (CMR) has evolved into a cardiac stress testing modality that can be used to diagnose myocardial ischemia using intravenous dobutamine or vasodilator perfusion agents such as adenosine or dipyridamole. Because CMR produces high-resolution tomographic images of the human heart in multiple imaging planes, it has become a highly attractive noninvasive testing modality for those suspected of having myocardial ischemia. The purpose of this article is to review the clinical, diagnostic, and prognostic utility of stress CMR testing for patients with (or suspected of having) coronary artery disease.
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Affiliation(s)
- Runyawan Chotenimitkhun
- Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA
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Jahnke C, Furundzija V, Gebker R, Manka R, Frick M, Schnackenburg B, Marx N, Paetsch I. Gender-based prognostic value of pharmacological cardiac magnetic resonance stress testing: head-to-head comparison of adenosine perfusion and dobutamine wall motion imaging. Int J Cardiovasc Imaging 2011; 28:1087-98. [PMID: 21732028 DOI: 10.1007/s10554-011-9919-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 06/24/2011] [Indexed: 12/28/2022]
Abstract
This study evaluated the gender related long-term prognostic value of adenosine perfusion and dobutamine wall motion imaging as assessed during a combined single-session stress cardiac magnetic resonance (CMR) examination. In 717 patients a combined CMR stress examination was performed. Inducible perfusion deficits and wall motion abnormalities were identified visually. Clinical parameters were assessed at the time of the CMR examination. All patients were contacted to determine the occurrence of hard cardiac events (cardiac death, myocardial infarction) during a median follow-up period of 5.3 years. A complete combined CMR examination and follow-up data were available in 679 patients (471 men). A total of 77 hard cardiac events (63 in men) occurred during follow-up. Multivariate analysis revealed the presence of inducible perfusion deficits or wall motion abnormalities as independent predictors of hard cardiac events for both gender with an incremental value over conventional cardiovascular risk factors. In case of a negative stress test result, event-free survival was 100% in women for 4 years and >99% in men for 2 years after the CMR examination. CMR perfusion and wall motion testing are equally suited for cardiac risk stratification in men and women. Stress CMR negative women exhibited very low event rates up to 4 years following the examination, while in men annual event rates increased after the second year. Consequently, the generally proposed 2-year warranty period of non-invasive stress testing may be prolonged to a 4 year level in CMR stress testing negative women.
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Affiliation(s)
- Cosima Jahnke
- Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Karamitsos TD, Dall'Armellina E, Choudhury RP, Neubauer S. Ischemic heart disease: comprehensive evaluation by cardiovascular magnetic resonance. Am Heart J 2011; 162:16-30. [PMID: 21742086 DOI: 10.1016/j.ahj.2011.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
Abstract
Considerable technical advances over the past decade have increased the clinical application of cardiovascular magnetic resonance (CMR) imaging. A comprehensive CMR examination can accurately measure left and right ventricular size and function, identify the presence and extent of reversible versus irreversible myocardial injury, and detect inducible ischemia. Streamlined protocols allow such a CMR examination to be a time-efficient diagnostic tool in patients with coronary artery disease. Moreover, edema imaging with T2-weighted CMR allows the detection of acute coronary syndromes. In this review, we present the relevant CMR methods and discuss practical uses of CMR in acute and chronic ischemic heart disease.
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Sievers B, Jacobi L, Sommer P, Speiser U, Schoen S, Strasser RH. Influence of adenosine on ventricular function measurements as part of a comprehensive stress perfusion magnetic resonance imaging study. Acta Radiol 2011; 52:624-31. [PMID: 21525106 DOI: 10.1258/ar.2011.100492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Stress-rest perfusion magnetic resonance imaging (MRI) has become one of the major indications for cardiovascular MRI. Standard multibreath hold short-axis image acquisition is the gold standard for LV function assessment and part of a comprehensive stress-rest perfusion MRI study, but takes up to 10 min. The total scan time could significantly be shortened when cine imaging would be performed between stress and rest perfusion. PURPOSE To systematically study whether adenosine, albeit its short half-life time, influences LV function measurements in this setting. MATERIAL AND METHODS Thirty-nine patients with suspected and/or known coronary artery disease underwent 3-Tesla adenosine (140 µg/min/kg) stress-rest perfusion MRI. A stack of short-axis slices covering the entire ventricles was acquired before and ≥3 min after adenosine infusion using standard multibreath-hold 2D steady-state free precession imaging. LV volumes (EDV, ESV), EF, and mass were calculated by the slice summation method, and wall motion was assessed using a 4-point scoring scale. Reproducibility was assessed by Bland-Altman statistics. RESULTS EDV, ESV, EF, and mass were not significantly different between the two imaging time points (before versus after adenosine administration) in all patients (P ≥ 0.346) and patients with impaired LV function (P ≥ 0.718). Wall motion scores did not differ either (P ≥ 0.124). Inter-observer variability before (P ≥ 0.468) and after (P ≥ 0.451) adenosine infusion was low. CONCLUSION Short-axis cine imaging for LV function assessment can accurately be performed between stress and rest imaging. These data demonstrate that potential effects of adenosine on LV function are of short duration, and propose a new time-saving imaging protocol without compromising accuracy.
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Affiliation(s)
- Burkhard Sievers
- Division of Cardiology, Pulmology and Vascular Medicine, University Hospital, Duesseldorf
| | - Liane Jacobi
- Department of Cardiology, Heart Center Dresden, University Hospital, University of Technology Dresden, Dresden, Germany
| | - Philipp Sommer
- Department of Cardiology, Heart Center Dresden, University Hospital, University of Technology Dresden, Dresden, Germany
| | - Uwe Speiser
- Department of Cardiology, Heart Center Dresden, University Hospital, University of Technology Dresden, Dresden, Germany
| | - Steffen Schoen
- Department of Cardiology, Heart Center Dresden, University Hospital, University of Technology Dresden, Dresden, Germany
| | - Ruth H Strasser
- Department of Cardiology, Heart Center Dresden, University Hospital, University of Technology Dresden, Dresden, Germany
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de Mello RAF, Nacif MS, dos Santos AASMD, Cury RC, Rochitte CE, Marchiori E. Diagnostic performance of combined cardiac MRI for detection of coronary artery disease. Eur J Radiol 2011; 81:1782-9. [PMID: 21664778 DOI: 10.1016/j.ejrad.2011.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 05/14/2011] [Accepted: 05/19/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of stress perfusion cardiac MR (CMR) for detecting significant CAD (≥70% narrowing) in comparison with invasive coronary angiography (ICA) as a reference standard. METHODS Examinations of 54 patients who underwent both stress perfusion CMR and ICA for investigation of CAD between 2007 and 2009 were evaluated. The CMR protocol included dipyridamole stress and rest perfusion, stress and rest cine MRI for assessment of ventricular function and delayed gadolinium enhancement for assessment of myocardial viability and detection of infarction. CMR interpretation was performed by 2 observers blinded to the results of ICA and the clinical history. RESULTS From a total of 54 patients, 37 (68.5%) showed significant CAD in 71 coronary territories. A perfusion defect was detected in 35 patients and in 69 coronary territories. Individual stress perfusion CMR evaluation showed the highest accuracy (83%) of the CMR techniques. The combined analysis using all sequences increased the overall accuracy of CMR to 87%. CONCLUSION Combination of perfusion and cine-MR during stress/rest, associated to delayed enhancement in the same protocol improves CMRI diagnostic accuracy and sensitivity for patients with significant coronary stenosis, and may therefore be helpful for risk stratification and defining treatment strategies.
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Kirschbaum SW, de Feyter PJ, van Geuns RJM. Cardiac magnetic resonance imaging in stable ischaemic heart disease. Neth Heart J 2011; 19:229-35. [PMID: 21487751 PMCID: PMC3087021 DOI: 10.1007/s12471-011-0106-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac magnetic resonance imaging (CMR) is a new robust versatile non-invasive imaging technique that can detect global and regional myocardial dysfunction, presence of myocardial ischaemia and myocardial scar tissue in one imaging session without radiation, with superb spatial and temporal resolution, inherited three-dimensional data collection and with relatively safe contrast material. The reproducibility of CMR is high which makes it possible to use this technique for serial assessment to evaluate the effect of revascularisation therapy in patients with ischaemic heart disease.
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Affiliation(s)
- S W Kirschbaum
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, room Ba 585, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
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Stress perfusion imaging using cardiovascular magnetic resonance: a review. Heart Lung Circ 2011; 19:697-705. [PMID: 20869310 DOI: 10.1016/j.hlc.2010.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 01/25/2023]
Abstract
Stress perfusion CMR can provide both excellent diagnostic and important prognostic information in the context of a comprehensive assessment of cardiac anatomy and function. This coupled with the high spatial resolution, and the lack of both attenuation artefacts and ionising radiation, make CMR stress perfusion imaging a highly attractive stress imaging modality. It is now in routine use in many centres, and shows promise in evaluating patients with clinical problems beyond those of epicardial coronary disease.
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Cheung SCW, Chan CWS. Cardiac magnetic resonance imaging: choice of the year: which imaging modality is best for evaluation of myocardial ischemia? (MRI-side). Circ J 2011; 75:724-30; discussion 723. [PMID: 21301137 DOI: 10.1253/circj.cj-10-1269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The increasing variety of available cardiac imaging techniques have made the investigation of coronary artery disease more complex. On the one hand, nuclear cardiology or myocardial perfusion imaging (MPI) allows accurate and reliable quantitative measurement of myocardial blood flow. On the other hand, a newer technique, cardiac magnetic resonance imaging (CMR) is an attractive alternative for achieving similar purposes without exposing patients to radiation hazards. With a higher spatial resolution, CMR is more sensitive for detecting subendocardial ischemia; small myocardial infarction and/or fibrosis, which cannot be achieved in a nuclear study. Nuclear MPI has dominated clinical practice over the past 3 decades on the basis of an extensive amount of research. More upcoming research on CMR would warrant more evidence-based data of its value for disease diagnosis, prognosis and risk stratification and incorporating it into the clinical diagnostic and management algorithm.
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Manka R, Vitanis V, Boesiger P, Flammer AJ, Plein S, Kozerke S. Clinical Feasibility of Accelerated, High Spatial Resolution Myocardial Perfusion Imaging. JACC Cardiovasc Imaging 2010; 3:710-7. [DOI: 10.1016/j.jcmg.2010.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/18/2010] [Accepted: 03/23/2010] [Indexed: 01/07/2023]
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Daly C, Coelho-Filho OR, Kwong RY. Recent Developments in Outcomes Research in Cardiovascular MRI. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9023-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hamon M, Fau G, Née G, Ehtisham J, Morello R, Hamon M. Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery disease. J Cardiovasc Magn Reson 2010; 12:29. [PMID: 20482819 PMCID: PMC2890682 DOI: 10.1186/1532-429x-12-29] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 05/19/2010] [Indexed: 02/09/2023] Open
Abstract
AIM Evaluation of the diagnostic accuracy of stress perfusion cardiovascular magnetic resonance for the diagnosis of significant obstructive coronary artery disease (CAD) through meta-analysis of the available data. METHODOLOGY Original articles in any language published before July 2009 were selected from available databases (MEDLINE, Cochrane Library and BioMedCentral) using the combined search terms of magnetic resonance, perfusion, and coronary angiography; with the exploded term coronary artery disease. Statistical analysis was only performed on studies that: (1) used a [greater than or equal to] 1.5 Tesla MR scanner; (2) employed invasive coronary angiography as the reference standard for diagnosing significant obstructive CAD, defined as a [greater than or equal to] 50% diameter stenosis; and (3) provided sufficient data to permit analysis. RESULTS From the 263 citations identified, 55 relevant original articles were selected. Only 35 fulfilled all of the inclusion criteria, and of these 26 presented data on patient-based analysis. The overall patient-based analysis demonstrated a sensitivity of 89% (95% CI: 88-91%), and a specificity of 80% (95% CI: 78-83%). Adenosine stress perfusion CMR had better sensitivity than with dipyridamole (90% (88-92%) versus 86% (80-90%), P = 0.022), and a tendency to a better specificity (81% (78-84%) versus 77% (71-82%), P = 0.065). CONCLUSION Stress perfusion CMR is highly sensitive for detection of CAD but its specificity remains moderate.
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Affiliation(s)
- Michèle Hamon
- Department of Radiology, University Hospital of Caen, France
- INSERM 919, Cyceron, Caen, France
| | - Georges Fau
- Department of Radiology, University Hospital of Caen, France
| | | | - Javed Ehtisham
- Department of Cardiology, University Hospital of Caen, France
| | - Rémy Morello
- Department of Statistics, University Hospital of Caen, France
| | - Martial Hamon
- Department of Cardiology, University Hospital of Caen, France
- INSERM 744, Institut Pasteur de Lille, France
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Diagnostik der koronaren Herzerkrankung mit Computer- und Magnetresonanztomographie. Internist (Berl) 2010; 51:625-38; quiz 639-40. [DOI: 10.1007/s00108-010-2585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Postpartum unmasking of a severe triple-vessel-disease with acute myocardial infarction. Clin Res Cardiol 2010; 99:463-6. [DOI: 10.1007/s00392-010-0123-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/20/2010] [Indexed: 11/26/2022]
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Abstract
Coronary heart disease (CHD) remains the leading cause of death in women. However, there are multiple challenges to the diagnosis of CHD in women, including: 1) women perceive their risk of CHD to be lower than it truly is, 2) women frequently present with atypical cardiac symptoms, 3) traditional stress tests have lower accuracy in women than in men, 4) women have a lower frequency of obstructive CHD detected at angiography than do men, and 5) a high percentage of women without obstructive CHD by invasive angiography have recurrent chest pain. Given the increasing number of options and complexity of noninvasive testing for CHD, it is important for women's health care providers to select the best test for a given patient. Newer imaging modalities such as cardiac computed tomography and magnetic resonance imaging offer speed, convenience, and high diagnostic accuracy in women. The goal of this article is to provide practitioners with an overview of the conventional diagnostic tests and to compare these with the newer imaging modalities. The appropriate application of diagnostic tests should allow practitioners to identify accurately and reassure those patients who are at low risk while targeting those who have preclinical or symptomatic atherosclerosis so that they can receive aggressive medical therapy, referral to cardiovascular specialists, or both.
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Okada DR, Ghoshhajra BB, Blankstein R, Rocha-Filho JA, Shturman LD, Rogers IS, Bezerra HG, Sarwar A, Gewirtz H, Hoffmann U, Mamuya WS, Brady TJ, Cury RC. Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT. J Nucl Cardiol 2010; 17:27-37. [PMID: 19936863 PMCID: PMC2946891 DOI: 10.1007/s12350-009-9156-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Accepted: 09/29/2009] [Indexed: 12/01/2022]
Abstract
INTRODUCTION We have recently described a technique for assessing myocardial perfusion using adenosine-mediated stress imaging (CTP) with dual source computed tomography. SPECT myocardial perfusion imaging (SPECT-MPI) is a widely utilized and extensively validated method for assessing myocardial perfusion. The aim of this study was to determine the level of agreement between CTP and SPECT-MPI at rest and under stress on a per-segment, per-vessel, and per-patient basis. METHODS Forty-seven consecutive patients underwent CTP and SPECT-MPI. Perfusion images were interpreted using the 17 segment AHA model and were scored on a 0 (normal) to 3 (abnormal) scale. Summed rest and stress scores were calculated for each vascular territory and patient by adding corresponding segmental scores. RESULTS On a per-segment basis (n = 799), CTP and SPECT-MPI demonstrated excellent correlation: Goodman-Kruskall gamma = .59 (P < .0001) for stress and .75 (P < .0001) for rest. On a per-vessel basis (n = 141), CTP and SPECT-MPI summed scores demonstrated good correlation: Pearson r = .56 (P < .0001) for stress and .66 (P < .0001) for rest. On a per-patient basis (n = 47), CTP and SPECT-MPI demonstrated good correlation: Pearson r = .60 (P < .0001) for stress and .76 (P < .0001) for rest. CONCLUSIONS CTP compares favorably with SPECT-MPI for detection, extent, and severity of myocardial perfusion defects at rest and stress.
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Affiliation(s)
- David R. Okada
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Brian B. Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ron Blankstein
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Non-invasive Cardiovascular Imaging Program, Department of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA
| | - Jose A. Rocha-Filho
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Leonid D. Shturman
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ian S. Rogers
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Hiram G. Bezerra
- Harrington McLaughlin Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH
| | - Ammar Sarwar
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Henry Gewirtz
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Wilfred S. Mamuya
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Lown Cardiovascular Group, Brookline, MA
| | - Thomas J. Brady
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ricardo C. Cury
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- ; Cardiovascular MR and CT Program, Baptist Cardiac and Vascular Institute, Miami, FL
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The many facets of cardiovascular magnetic resonance imaging: review of background, clinical utility, and increasing use in the community hospital. South Med J 2009; 102:719-24. [PMID: 19488003 DOI: 10.1097/smj.0b013e3181a8e2c6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular magnetic resonance imaging (CMR or cardiac MRI) has advanced dramatically in the last ten years and has been proven a reliable and flexible method for cardiac diagnosis. Stress perfusion MRI is a new technique that accurately detects coronary heart disease with high sensitivity and specificity. The role of CMR is also increasing for the evaluation of congestive heart failure and cardiomyopathy. Late gadolinium enhancement highlights areas of myocardial scar and helps predict prognosis. CMR usually complements, but does not fully replace, other diagnostic modalities. Careful patient selection is required to ensure safety in the presence of this powerful magnetic field. MRI gives unique tissue characterization without ionizing radiation. No longer used just for esoteric conditions, CMR is becoming common in the community hospital.
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Wallace EL, Morgan TM, Walsh TF, Dall’Armellina E, Ntim W, Hamilton CA, Hundley WG. Dobutamine cardiac magnetic resonance results predict cardiac prognosis in women with known or suspected ischemic heart disease. JACC Cardiovasc Imaging 2009; 2:299-307. [PMID: 19356575 PMCID: PMC2920607 DOI: 10.1016/j.jcmg.2008.10.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/14/2008] [Accepted: 10/16/2008] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the prognostic utility of dobutamine cardiac magnetic resonance (DCMR) stress test results in women. BACKGROUND To date, the preponderance of studies reporting the utility of DCMR stress results for predicting cardiac prognosis have been performed in men. We sought to determine the utility of DCMR results for predicting cardiac prognosis in women. METHODS Two hundred sixty-six consecutively referred women underwent DCMR in which left ventricular wall motion (LVWM) was assessed at rest and after intravenous dobutamine and atropine. Inducible LVWM abnormalities were identified during testing. Women were contacted to determine the post-DCMR occurrence of a cardiac event. All events were substantiated according to defined criteria and then were verified after a thorough medical record review by individuals blinded to testing data. RESULTS Women were contacted an average of 6.2 +/- 1.6 (median 6.2, range 0.8 to 10.4) years after DCMR; 27% of the women experienced an inducible LVWM abnormality during testing. In those with and without inducible LVWM abnormalities, the proportion of women with cardiac events were 63% versus 30%, respectively, (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.8 to 4.3 for the presence of inducible LVWM abnormalities p < 0.0001). The proportion of women with myocardial infarction (MI) and cardiac death were 33.3% and 7.5%, respectively. This resulted in a HR for MI and cardiac death of 4.1 (95% CI: 2.2 to 9.4) for those with versus those without inducible LVWM abnormalities; p < 0.0001. A subgroup analysis was performed in women without a history of coronary artery disease and in those with LVWM abnormalities, DCMR remained an adverse predictor of cardiac events (HR: 4.0, 95% CI: 1.8 to 9.0, p = 0.003). CONCLUSIONS Inducible LVWM abnormalities during DCMR predict cardiac death and MI in women. Similar to men, these results indicate that DCMR is a valuable noninvasive stress imaging modality for identifying cardiac risk in women with known or suspected ischemic heart disease.
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Affiliation(s)
- Eric L. Wallace
- Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Timothy M. Morgan
- Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Thomas F. Walsh
- Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Erica Dall’Armellina
- Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - William Ntim
- Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Craig A. Hamilton
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - W. Gregory Hundley
- Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
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Halvorsen S, Risøe C. Symptomer og diagnostikk av koronarsykdom hos kvinner. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:1853-7. [DOI: 10.4045/tidsskr.09.0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Selvanayagam J. Women With Chest Pain. JACC Cardiovasc Imaging 2008; 1:446-9. [DOI: 10.1016/j.jcmg.2008.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 04/29/2008] [Accepted: 04/29/2008] [Indexed: 10/21/2022]
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