title: Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease.
abstract: This study was performed to assess the role of additional myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR-wall motion) for the evaluation of patients with intermediate (50-70%) coronary artery stenosis. Routine DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 174 consecutive patients with chest pain syndromes who were scheduled for a clinically indicated coronary angiography. When defining CAD as the presence of a ≥ 50% stenosis, the addition of perfusion imaging improved sensitivity (90 vs. 79%, P < 0.001) with a non-significant reduction in specificity (85 vs. 90%, P = 0.13) and an improvement in overall diagnostic accuracy (88 vs. 84%, P = 0.008). Adding perfusion imaging improved sensitivity in patients with intermediate stenosis (87 vs. 72%, P = 0.03), but not in patients with severe (≥70%) stenosis (93 vs. 84%, P = 0.06). In patients with severe stenosis specificity of DSMR-perfusion versus DSMR-wall motion decreased (61 vs 70%, P = 0.001) resulting in a lower overall accuracy (71 vs 74%, P = 0.03). Using a cutoff of ≥50% for the definition of CAD, sensitivity of DSMR-perfusion compared to DSMR-wall motion was significantly higher in patients with single vessel (88 vs. 77%, P = 0.03) and multi vessel disease (93 vs. 79%, P = 0.03), whereas no significant differences were found using a cutoff of ≥70% stenosis for the definition of CAD. The addition of perfusion imaging during DSMR-wall motion improved the sensitivity in patients with intermediate coronary artery stenosis. Overall diagnostic accuracy increased only when defining CAD as ≥50% stenosis. In patients with ≥70% stenosis DSMR-wall motion alone had higher accuracy due to more false-positive cases with DSMR-perfusion.
authors.affiliation: German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. gebker@dhzb.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.forename: M
authors.initials: M
authors.lastname: Frick
authors.forename: C
authors.initials: C
authors.lastname: Jahnke
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.forename: C
authors.initials: C
authors.lastname: Schneeweis
authors.forename: R
authors.initials: R
authors.lastname: Manka
authors.forename: S
authors.initials: S
authors.lastname: Kelle
authors.forename: C
authors.initials: C
authors.lastname: Klein
authors.forename: B
authors.initials: B
authors.lastname: Schnackenburg
authors.forename: E
authors.initials: E
authors.lastname: Fleck
authors.forename: I
authors.initials: I
authors.lastname: Paetsch
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002637:Chest Pain / Q000150:complications; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000473:pathology*; D023921:Coronary Stenosis / Q000150:complications / Q000473:pathology; D004280:Dobutamine; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D004280:Dobutamine; D019786:Gadolinium DTPA