Comprehensive adenosine stress perfusion MRI defines the etiology of chest pain in the emergency room: Comparison with nuclear stress test.
OBJECTIVE
To compare standard of care nuclear SPECT imaging with cardiac magnetic resonance imaging (MRI) for emergency room (ER) patients with chest pain and intermediate probability for coronary artery disease.


METHODS
Thirty-one patients with chest pain, negative electrocardiogram (ECG), and negative cardiac enzymes who underwent cardiac single photon emission tomography (SPECT) within 24 h of ER admission were enrolled. Patients underwent a comprehensive cardiac MRI exam including gated cine imaging, adenosine stress and rest perfusion imaging and delayed enhancement imaging. Patients were followed for 14 +/- 4.7 months.


RESULTS
Of 27 patients, 8 (30%) showed subendocardial hypoperfusion on MRI that was not detected on SPECT. These patients had a higher rate of diabetes (P = 0.01) and hypertension (P = 0.01) and a lower global myocardial perfusion reserve (P = 0.01) compared with patients with a normal cardiac MRI (n = 10). Patients with subendocardial hypoperfusion had more risk factors for cardiovascular disease (mean 4.4) compared with patients with a normal MRI (mean 2.5; P = 0.005). During the follow-up period, patients with subendocardial hypoperfusion on stress MRI were more likely to return to the ER with chest pain compared with patients who had a normal cardiac MRI (P = 0.02). Four patients did not finish the MR exam due to claustrophobia.


CONCLUSIONS
In patients with chest pain, diabetes and hypertension, cardiac stress perfusion MRI identified diffuse subendocardial hypoperfusion defects in the ER setting not seen on cardiac SPECT, which is suspected to reflect microvascular disease.
Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology, Baltimore, Maryland 21287, USA. jclauss1@jhmi.edu
Jens
J
Vogel-Claussen
Jan
J
Skrok
David
D
Dombroski
Steven M
SM
Shea
Edward P
EP
Shapiro
Mark
M
Bohlman
Christine H
CH
Lorenz
Joao A C
JA
Lima
David A
DA
Bluemke
D000241:Adenosine; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D017023:Coronary Angiography; D003326:Coronary Circulation; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D000241:Adenosine