Value of cardiovascular magnetic resonance stress perfusion testing for the detection of coronary artery disease in women.
OBJECTIVE
We wanted to assess the value of cardiovascular magnetic resonance (CMR) stress testing for evaluation of women with suspected coronary artery disease (CAD).


BACKGROUND
A combined perfusion and infarction CMR examination can accurately diagnose CAD in the clinical setting in a mixed gender population.


METHODS
We prospectively enrolled 147 consecutive women with chest pain or other symptoms suggestive of CAD at 2 centers (Duke University Medical Center, Robert-Bosch-Krankenhaus). Each patient underwent a comprehensive clinical evaluation, a CMR stress test consisting of cine rest function, adenosine-stress and rest perfusion, and delayed-enhancement CMR infarction imaging, and X-ray coronary angiography within 24 h. The components of the CMR test were analyzed visually both in isolation and combined using a pre-specified algorithm. Coronary artery disease was defined as stenosis > or =70% on quantitative analysis of coronary angiography.


RESULTS
Cardiovascular magnetic resonance imaging was completed in 136 females (63.0 +/- 11.1 years), 37 (27%) women had CAD on coronary angiography. The combined CMR stress test had a sensitivity, specificity, and accuracy of 84%, 88%, and 87%, respectively, for the diagnosis of CAD. Diagnostic accuracy was high at both sites (Duke University Medical Center 82%, Robert-Bosch-Krankenhaus 90%; p = 0.18). The accuracy for the detection of CAD was reduced when intermediate grade stenoses were included (82% vs. 87%; p = 0.01 compared the cutoff of stenosis > or =50% vs. > or =70%). The sensitivity was lower in women with single-vessel disease (71% vs. 100%; p = 0.06 compared with multivessel disease) and small left ventricular mass (69% vs. 95%; p = 0.04 for left ventricular mass < or =97 g vs. >97 g). The latter difference was even more significant after accounting for end-diastolic volumes (70% vs. 100%; p = 0.02 for left ventricular mass indexed to end-diastolic volume < or =1.15 g/ml vs. >1.15 g/ml).


CONCLUSIONS
A multicomponent CMR stress test can accurately diagnose CAD in women. Detection of CAD in women with intermediate grade stenosis, single-vessel disease, and with small hearts is challenging.
Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina 27710, USA. igor.klem@duke.edu
Igor
I
Klem
Simon
S
Greulich
John F
JF
Heitner
Han
H
Kim
Holger
H
Vogelsberg
Eva-Maria
EM
Kispert
Srivani R
SR
Ambati
Christian
C
Bruch
Michele
M
Parker
Robert M
RM
Judd
Raymond J
RJ
Kim
Udo
U
Sechtem
D000241:Adenosine; D000368:Aged; D000465:Algorithms; D000787:Angina Pectoris / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005060:Europe; D005080:Exercise Test; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume; D014481:United States; D016387:Women's Health
D000241:Adenosine