title: Impact of arrhythmia on diagnostic performance of adenosine stress CMR in patients with suspected or known coronary artery disease.
abstract: BACKGROUND
  The diagnostic performance of adenosine stress cardiovascular magnetic resonance (CMR) in patients with arrhythmias presenting for work-up of suspected or known CAD is largely unknown, since most CMR studies currently available exclude arrhythmic patients from analysis fearing gating problems, or other artifacts will impair image quality. The primary aim of our study was to evaluate the diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for 1) work-up of suspected coronary artery disease (CAD), or 2) work-up of ischemia in known CAD.
  
  
  METHODS
  Patients with arrhythmia referred for work-up of suspected CAD or work-up of ischemia in known CAD undergoing adenosine stress CMR were included if they had coronary angiography within four weeks of CMR.
  
  
  RESULTS
  One hundred fifty-nine patients were included (n = 64 atrial fibrillation, n = 87 frequent ventricular extrasystoles, n = 8 frequent supraventricular extrasystoles). Of these, n = 72 had suspected CAD, and n = 87 had known CAD. Diagnostic accuracy of the adenosine stress CMR for detection of significant CAD was 73 % for the entire population (sensitivity 72 %, specificity 76 %). Diagnostic accuracy was 75 % (sensitivity 80 %, specificity 74 %) in patients with suspected CAD, and 74 % (sensitivity 71 %, specificity 79 %) in the group with known CAD. For different types of arrhythmia, diagnostic accuracy of CMR was 70 % in the atrial fibrillation group, and 79 % in patients with ventricular extrasystoles. On a per coronary territory analysis, diagnostic accuracy of CMR was 77 % for stenosis of the left and 82 % for stenosis of the right coronary artery.
  
  
  CONCLUSIONS
  The present data demonstrates good diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for work-up of suspected CAD, or work-up of ischemia in known CAD. This holds true for a per patient, as well as for a per coronary territory analysis.
authors.affiliation: Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Greulich
authors.affiliation: Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Hannah
authors.initials: H
authors.lastname: Steubing
authors.affiliation: Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Birkmeier
authors.affiliation: Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grün
authors.affiliation: Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bentz
authors.affiliation: Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Heiko.Mahrholdt@rbk.de.
authors.forename: Heiko
authors.initials: H
authors.lastname: Mahrholdt
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016477:Artifacts; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine