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


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


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


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


CONCLUSIONS
Cardiac magnetic resonance imaging accurately predicts the presence of significant CAD in patients with NSTE-ACS. In this study, a comprehensive analysis of several CMR methods improved the accuracy of the test.
Plein
Sven
S
BHF-Cardiac Magnetic Resonance Unit, the General Infirmary at Leeds, Leeds, United Kingdom. sven.plein@leedsth.nhs.uk
Greenwood
John P
JP
Ridgway
John P
JP
Cranny
Gillian
G
Ball
Stephen G
SG
Sivananthan
Mohan U
MU
D000241:Adenosine; D000328:Adult; D000368:Aged; D002932:Cineangiography; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D012680:Sensitivity and Specificity; D013577:Syndrome; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D000241:Adenosine