title: The value of stress perfusion cardiovascular magnetic resonance imaging for patients referred from the adult congenital heart disease clinic: 5-year experience at the Toronto General Hospital.
abstract: BACKGROUND
  Vasodilator stress perfusion cardiovascular magnetic resonance imaging is a clinically useful tool for detection of clinically significant myocardial ischaemia in adults. We report our 5-year retrospective experience with perfusion cardiovascular magnetic resonance in a large, quarternary adult congenital heart disease centre.
  
  
  METHODS
  We reviewed all cases of perfusion cardiovascular magnetic resonance in patients referred from the adult congenital heart disease service. Dipyridamole stress perfusion cardiovascular magnetic resonance was undertaken on commercially available 1.5 and 3 T cardiovascular magnetic resonance scanners. Late gadolinium enhancement imaging was performed 8-10 minutes after completion of the rest perfusion sequence. Navigator whole-heart coronary magnetic resonance angiography was also performed where feasible. RESULTS of stress cardiovascular magnetic resonance were correlated with complementary imaging studies, surgery, and clinical outcomes.
  
  
  RESULTS
  Over 5 years, we performed 34 stress perfusion cardiovascular magnetic resonance examinations (11 positive). In all, 84% of patients had further investigations for ischaemia in addition to cardiovascular magnetic resonance. Within a subgroup of 19 patients who had definitive alternative assessment of their coronary arteries, stress perfusion cardiovascular magnetic resonance demonstrated a sensitivity of 82% and specificity of 100%. Of the 34 studies, two were false negatives, in which the aetiology of ischaemia was extrinsic arterial compression rather than intrinsic coronary luminal narrowing. Coronary abnormalities were identified in 71% of cases who had coronary magnetic resonance angiography.
  
  
  CONCLUSIONS
  Stress perfusion cardiovascular magnetic resonance is a useful and accurate tool for investigation of myocardial ischaemia in an adult congenital heart disease population with suspected non-atherosclerotic coronary abnormalities.
authors.affiliation: 1Department of Medical Imaging,Peter Munk Cardiac Centre,Toronto General Hospital,University of Toronto,Ontario,Canada.
authors.forename: Djeven P
authors.initials: DP
authors.lastname: Deva
authors.affiliation: 2Radiology Department,Hospital de Clínicas de Porto Alegre,Porto Alegre,Rio Grande do Sul,Brazil.
authors.forename: Felipe S
authors.initials: FS
authors.lastname: Torres
authors.affiliation: 3Division of Cardiology,Peter Munk Cardiac Centre,Toronto General Hospital,University of Toronto,Ontario,Canada.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Wald
authors.affiliation: 3Division of Cardiology,Peter Munk Cardiac Centre,Toronto General Hospital,University of Toronto,Ontario,Canada.
authors.forename: S Lucy
authors.initials: SL
authors.lastname: Roche
authors.affiliation: 4Department of Medical Imaging,Sunnybrook Health Sciences Centre,Toronto,Ontario,Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Jimenez-Juan
authors.affiliation: 3Division of Cardiology,Peter Munk Cardiac Centre,Toronto General Hospital,University of Toronto,Ontario,Canada.
authors.forename: Erwin N
authors.initials: EN
authors.lastname: Oechslin
authors.affiliation: 1Department of Medical Imaging,Peter Munk Cardiac Centre,Toronto General Hospital,University of Toronto,Ontario,Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Crean
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006769:Hospitals, General; D006801:Humans; D007262:Infusions, Intravenous; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009864:Ontario; D055420:Perfusion Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents