[Combined evaluation of myocardial perfusion and contractility by cardiac magnetic resonance with adenosine stress test: feasibility and accuracy in detecting coronary artery disease].
BACKGROUND
Protocols of cardiac magnetic resonance imaging (CMR) during pharmacological stress with adenosine may include scanning sequences for the evaluation of both myocardial perfusion and contractility. The aim of this study was to define the feasibility and diagnostic accuracy of a stress CMR protocol including the combined evaluation of regional myocardial perfusion and contractility in the identification of patients with significant coronary artery disease.


METHODS
A total of 184 consecutive patients with known or suspected coronary artery disease underwent stress CMR (adenosine, 140 microg/kg/min). The employed protocol included the application of the following sequences for image acquisition: 1) cine imaging at rest; 2) perfusion imaging (Gd-DTPA, 0.05 mmol/kg) during pharmacological stress; 3) cine imaging during pharmacological stress; 4) perfusion imaging (Gd-DTPA, 0.05 mmol/kg) at rest.


RESULTS
Stress CMR was completed in 182 patients (99%). Minor complications were observed in 12 patients (7%) during adenosine infusion, while one patient developed severe bronchospasm and another patient experienced persistent myocardial ischemia. Good/excellent-quality images were obtained in 91% of stress CMR exams. In a subgroup of 37 patients, when compared with the use of perfusion images alone, combination of perfusion and contractility data provided higher levels of sensitivity (74 vs 89%, p < 0.05) and of negative predictive value (71 vs 85%, p < 0.05) in identifying patients with significant coronary artery disease by invasive angiography.


CONCLUSIONS
Adenosine stress CMR including the evaluation of both myocardial perfusion and contractility is feasible and improves diagnostic performance in the recognition of patients with significant coronary artery disease.
Dellegrottaglie
Santo
S
Unità di Risonanza Magnetica Cardiaca, Dipartimento Cardiologico "A. De Gasperis", A.O. Niguarda Ca' Granda, Milano. Santo.Dellegrottaglie@mssm.edu
Cospite
Valentina
V
Pedrotti
Patrizia
P
Pedretti
Stefano
S
Lanzarin
Barbara
B
Mauri
Francesco
F
Roghi
Alberto
A
D000241:Adenosine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005080:Exercise Test / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D055414:Myocardial Perfusion Imaging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D000241:Adenosine