title: Concordance and diagnostic accuracy of vasodilator stress cardiac MRI and 320-detector row coronary CTA.
abstract: Vasodilator stress cardiac magnetic resonance (CMR) detects ischemia whereas coronary CT angiography (CTA) detects atherosclerosis. The purpose of this study was to determine concordance and accuracy of vasodilator stress CMR and coronary CTA in the same subjects. We studied 151 consecutive subjects referred to detect or exclude suspected obstructive coronary artery disease (CAD) in patients without known disease or recurrent stenosis or ischemia in patients with previously treated CAD. Vasodilator stress CMR was performed on a 1.5 T scanner. CTA was performed on a 320-detector row system. Subjects were followed for cardiovascular events and downstream diagnostic testing. Subjects averaged 56 ± 12 years (60% male), and 62 % had intermediate pre-test probability for obstructive CAD. Follow-up averaged 450 ± 115 days and was 100% complete. CMR and CTA agreed in 92% of cases (κ 0.81, p < 0.001). The event-free survival was 97 % for non-ischemic and 39% for ischemic CMR (p < 0.0001). The event-free survival was 99% for non-obstructive and 36% for obstructive CTA (p < 0.0001). Using a reference standard including quantitative invasive angiography or major cardiovascular events, CMR and CTA had respective sensitivities of 93 and 98 %; specificities of 96 and 96%; positive predictive values of 91 and 91%; negative predictive values of 97 and 99%; and accuracies of 95 and 97%. Non-ischemic vasodilator stress CMR or non-obstructive coronary CTA were highly concordant and each confer an excellent prognosis. CMR and CTA are both accurate for assessment of obstructive CAD in a predominantly intermediate risk population.
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.forename: W Patricia
authors.initials: WP
authors.lastname: Bandettini
authors.forename: Sujata M
authors.initials: SM
authors.lastname: Shanbhag
authors.forename: Sujethra
authors.initials: S
authors.lastname: Vasu
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Booker
authors.forename: Steve W
authors.initials: SW
authors.lastname: Leung
authors.forename: Joel R
authors.initials: JR
authors.lastname: Wilson
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.forename: Li-Yueh
authors.initials: LY
authors.lastname: Hsu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Arai
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents