Comparison of stress cardiovascular magnetic resonance imaging (CMR) with stress nuclear perfusion for the diagnosis of coronary artery disease.
OBJECTIVE
To assess the diagnostic performance of stress cardiac magnetic resonance (stress CMR) vs stress single-photon emission computed tomography (SPECT) in patients presenting to the emergency department (ED) with chest pain.


BACKGROUND
SPECT imaging is the most utilized outpatient procedure in the United States. The diagnostic accuracy of SPECT can be limited by soft tissue attenuation and low spatial resolution. Stress CMR has much higher spatial resolution and without the susceptibility to soft tissue attenuation.


METHODS
Eighty-seven patients without a history of CAD presenting to the ED with chest pain were prospectively enrolled. Patients underwent both stress CMR and stress SPECT imaging within 12 hours of presentation. Both the stress imaging tests were interpreted immediately for clinical purposes and coronary angiography was performed if either was abnormal. Patients were considered to have significant CAD if identified by angiography (≥50%) or if a cardiac event (cardiac death, myocardial infarction or revascularization) occurred during follow-up (mean 2.6 ± 1.1 years).


RESULTS
Thirty-seven patients were referred for coronary angiography; 29 due to a positive stress test and eight patients for persistent chest pain despite two negative stress tests. There were 22 patients who had significant CAD (≥50%). The remaining patients were followed for 2.6 ± 1.1 years. At the conclusion of the follow-up period, there were four clinical events. The sensitivity, specificity, and diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%, 91%, and 88%, respectively.


CONCLUSIONS
Stress CMR has similar diagnostic accuracy as stress SPECT in diagnosis of CAD.
Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA.
Ijaz G
IG
Ahmad
Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA.
Raushan K
RK
Abdulla
Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA.|Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Igor
I
Klem
Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA.
Roman
R
Margulis
Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA.
Alexander
A
Ivanov
Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA.
Ambreen
A
Mohamed
Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA.|Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Robert M
RM
Judd
Department of Radiology, Duke University Medical Center, Durham, NC, USA.
Salvatore
S
Borges-Neto
Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA.|Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Raymond J
RJ
Kim
Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA. john.heitner@gmail.com.|Department of Medicine, Duke University Medical Center, Durham, NC, USA. john.heitner@gmail.com.|Department of Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY, USA. john.heitner@gmail.com.
John F
JF
Heitner
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
Magnetic resonance imaging; coronary artery disease; myocardial perfusion imaging: SPECT