Prediction of necessity for coronary artery revascularization by adenosine contrast-enhanced magnetic resonance imaging.
BACKGROUND
Assessing myocardial first-pass wash-in during pharmacological induced stress allows detection of perfusion deficits and indicates stenotic coronary arteries (CA). The aim of our study was to demonstrate clinical relevance of contrast-enhanced stress magnetic resonance imaging (CMR) by predicting necessity of CA intervention.


METHODS
738 patients with scheduled coronary angiography (CXA) were scanned in a 1.5 Tesla CMR scanner. After 3 min of adenosine infusion (140 microg/kg/min), first-pass kinetic of contrast agent was evaluated. Myocardial necrosis was visualized with "myocardial late enhancement (MLE)". Perfusion deficits were described as either "ischemia in viable myocardium", or "no relevant ischemia in viable myocardium" or as "ischemia in chronic myocardial infarction (CMI)" based on spatial and temporal extent of ischemia and of MLE. CXA was performed in all patients within 48 h after CMR and revascularization, if applicable, was performed. Angiograms were read by two independent and blinded investigators and matched with CMR findings.


RESULTS
539 patients (73%) showed "ischemia in viable myocardium" and revascularization was performed in 513 patients (95%). In 111 patients with "no relevant ischemia in viable myocardium", revascularization was performed in only 5 patients (5%). In 88 patients classified as "ischemia in CMI", revascularization was performed in 14 patients (16%). Positive predictive value of CMR for CA intervention was 0.95, negative predictive value was 0.89, sensitivity was 0.96, and specificity was 0.87.


CONCLUSIONS
CMR allows clinical useful prediction of relevant CA disease with need for revascularization prior to CXA and may be used as non-invasive test for myocardial ischemia and viability to guide further therapy.
Bernhardt
Peter
P
MRI Center at the St. Gertrauden Hospital, Berlin, Germany. bernhardt@cardiovasc-mri.com
Engels
Thomas
T
Levenson
Benny
B
Haase
Katrin
K
Albrecht
Alexander
A
Strohm
Oliver
O
D000241:Adenosine; D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D000241:Adenosine