OBJECTIVES: This study was designed to determine the diagnostic value of adenosine cardiac magnetic resonance (CMR) in troponin-negative patients with chest pain. BACKGROUND: We hypothesized that adenosine CMR could determine which troponin-negative patients with chest pain in an emergency department have coronary artery disease (CAD) or future adverse cardiac events. METHODS: Adenosine stress CMR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction (MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as coronary artery stenosis >50% on angiography, abnormal correlative stress test, new MI, or death. RESULTS: Adenosine perfusion abnormalities had 100% sensitivity and 93% specificity as the single most accurate component of the CMR examination. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis (log-rank test, p = 0.0006 and p < 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosine CMR was a more accurate predictor than cardiac risk factors (p < 0.002). CONCLUSIONS: In patients with chest pain who had MI excluded by troponin-I and non-diagnostic electrocardiograms, an adenosine CMR examination predicted with high sensitivity and specificity which patients had significant CAD during one-year follow-up. Furthermore, no patients with a normal adenosine CMR study had a subsequent diagnosis of CAD or an adverse outcome.
OBJECTIVES: This study was designed to determine the diagnostic value of adenosine cardiac magnetic resonance (CMR) in troponin-negative patients with chest pain. BACKGROUND: We hypothesized that adenosine CMR could determine which troponin-negative patients with chest pain in an emergency department have coronary artery disease (CAD) or future adverse cardiac events. METHODS:Adenosine stress CMR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction (MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as coronary artery stenosis >50% on angiography, abnormal correlative stress test, new MI, or death. RESULTS:Adenosine perfusion abnormalities had 100% sensitivity and 93% specificity as the single most accurate component of the CMR examination. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis (log-rank test, p = 0.0006 and p < 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosine CMR was a more accurate predictor than cardiac risk factors (p < 0.002). CONCLUSIONS: In patients with chest pain who had MI excluded by troponin-I and non-diagnostic electrocardiograms, an adenosine CMR examination predicted with high sensitivity and specificity which patients had significant CAD during one-year follow-up. Furthermore, no patients with a normal adenosine CMR study had a subsequent diagnosis of CAD or an adverse outcome.
Authors: Erica Dall'Armellina; Theodoros D Karamitsos; Stefan Neubauer; Robin P Choudhury Journal: Nat Rev Cardiol Date: 2010-09-21 Impact factor: 32.419
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Authors: W Gregory Hundley; David A Bluemke; J Paul Finn; Scott D Flamm; Mark A Fogel; Matthias G Friedrich; Vincent B Ho; Michael Jerosch-Herold; Christopher M Kramer; Warren J Manning; Manesh Patel; Gerald M Pohost; Arthur E Stillman; Richard D White; Pamela K Woodard Journal: J Am Coll Cardiol Date: 2010-06-08 Impact factor: 24.094
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Authors: Arthur E Stillman; Matthijs Oudkerk; David A Bluemke; Menko Jan de Boer; Jens Bremerich; Ernest V Garcia; Matthias Gutberlet; Pim van der Harst; W Gregory Hundley; Michael Jerosch-Herold; Dirkjan Kuijpers; Raymond Y Kwong; Eike Nagel; Stamatios Lerakis; John Oshinski; Jean-François Paul; Riemer H J A Slart; Vinod Thourani; Rozemarijn Vliegenthart; Bernd J Wintersperger Journal: Int J Cardiovasc Imaging Date: 2018-03-19 Impact factor: 2.357
Authors: Kevin Steel; Ryan Broderick; Vijay Gandla; Eric Larose; Frederick Resnic; Michael Jerosch-Herold; Kenneth A Brown; Raymond Y Kwong Journal: Circulation Date: 2009-09-21 Impact factor: 29.690