Diagnostic performance of magnetic resonance first pass perfusion imaging is equally potent in female compared to male patients with coronary artery disease.
BACKGROUND
Noninvasive diagnosis of coronary artery disease (CAD) in women is crucial because of a lower prevalence of CAD in premenopausal women, different cardiac risk profile and pattern of CAD, lower exercise tolerance and more atypical symptoms compared to men. Therefore, we tested the diagnostic power of cardiac magnetic resonance first pass perfusion imaging (CMR-FPPI) for the diagnosis of significant coronary stenoses in females versus males.


RESULTS
256 consecutive patients, 77 females and 179 males with atypical or typical chest pain and intermediate risk of CAD were studied by coronary angiography and CMR-FPPI (1.5T Intera CV). A three-slice, short-axis perfusion scan with a saturation prepulse was performed during infusion of adenosine and at rest followed by late enhancement imaging for myocardial scar. Gadolinium-DTPA was administered at 0.1 mmol/kg body weight. Perfusion images were visually analysed, coronary stenoses by quantitative coronary angiography. Sensitivity, specificity and accuracy of CMR-FPPI for detection of a significant coronary artery stenosis (> or = 50% luminal narrowing) in the entire group were 91.3, 81.7 and 88.6%, the corresponding values for females were 90.9, 90.6 and 90.8% and for males 91.4, 74.4 and 87.7%, and in the subgroup of females with suspected primary CAD 83.3, 96.0 and 93.6%, and for suspected progression 92.1, 71.4 and 88.9%.


CONCLUSIONS
Diagnostic accuracy of CMR-FPPI is very high in women with intermediate risk of CAD and comparable or in part superior to results in males. With the advantage of the absence of radiation exposure and high spatial and temporal resolution, CMR-FPPI has the potential to become the preferred imaging test to select women for coronary angiography.
Merkle
Nico
N
Clinic of Internal Medicine II-Cardiology, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Wöhrle
Jochen
J
Nusser
Thorsten
T
Grebe
Olaf
O
Spiess
Jochen
J
Torzewski
Jan
J
Hombach
Vinzenz
V
D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000175:diagnosis; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
D003287:Contrast Media; D019786:Gadolinium DTPA