OBJECTIVES: We sought to assess the accuracy of an integrated cardiac magnetic resonance (CMR) protocol for the diagnosis of relevant coronary artery or bypass graft stenosis in patients with suspected coronary artery disease (CAD) or with previously performed percutaneous coronary intervention (PCI) or coronary bypass graft surgery (CABG). BACKGROUND: CMR is suitable for diagnosing inducible myocardial ischemia in patients with suspected CAD and has been proven to be a helpful diagnostic tool for decision of further treatment. However, little is known about its diagnostic accuracy in patients with known CAD who previously were treated by PCI or CABG. METHODS: A total of 477 patients with suspected CAD, 236 with previous PCI, and 110 after CABG referred for coronary X-ray angiography (CXA) underwent an integrated CMR examination before CXA. Myocardial ischemia was assessed using first-pass perfusion after vasodilator stress with adenosine (140 microg/kg/min for 3 min) using gadolinium-based contrast agents (0.1 mmol/kg). Late gadolinium enhancement (LGE) was assessed 10 min after a second contrast bolus. RESULTS: CXA demonstrated a relevant coronary vessel stenosis (> or =70% luminal reduction) in 313 (38%) patients using quantitative coronary analysis. The combination of CMR perfusion and LGE assessment for detecting a relevant coronary stenosis in patients with suspected CAD yielded sensitivity and specificity of 0.94 and 0.87, in PCI patients 0.91 and 0.90, and in CABG patients 0.79 and 0.77, respectively. CONCLUSIONS: A combined CMR protocol for the assessment of myocardial perfusion and LGE is feasible for the detection of relevant coronary vessel stenosis even in patients who previously were treated by PCI or CAG in a routine clinical setting. However, diagnostic accuracy is reduced in patients with CABG. This could be due to different flow and perfusion kinetic. Further studies are needed to optimize the clinical protocols especially in post-surgical patients.
OBJECTIVES: We sought to assess the accuracy of an integrated cardiac magnetic resonance (CMR) protocol for the diagnosis of relevant coronary artery or bypass graft stenosis in patients with suspected coronary artery disease (CAD) or with previously performed percutaneous coronary intervention (PCI) or coronary bypass graft surgery (CABG). BACKGROUND: CMR is suitable for diagnosing inducible myocardial ischemia in patients with suspected CAD and has been proven to be a helpful diagnostic tool for decision of further treatment. However, little is known about its diagnostic accuracy in patients with known CAD who previously were treated by PCI or CABG. METHODS: A total of 477 patients with suspected CAD, 236 with previous PCI, and 110 after CABG referred for coronary X-ray angiography (CXA) underwent an integrated CMR examination before CXA. Myocardial ischemia was assessed using first-pass perfusion after vasodilator stress with adenosine (140 microg/kg/min for 3 min) using gadolinium-based contrast agents (0.1 mmol/kg). Late gadolinium enhancement (LGE) was assessed 10 min after a second contrast bolus. RESULTS:CXA demonstrated a relevant coronary vessel stenosis (> or =70% luminal reduction) in 313 (38%) patients using quantitative coronary analysis. The combination of CMR perfusion and LGE assessment for detecting a relevant coronary stenosis in patients with suspected CAD yielded sensitivity and specificity of 0.94 and 0.87, in PCI patients 0.91 and 0.90, and in CABG patients 0.79 and 0.77, respectively. CONCLUSIONS: A combined CMR protocol for the assessment of myocardial perfusion and LGE is feasible for the detection of relevant coronary vessel stenosis even in patients who previously were treated by PCI or CAG in a routine clinical setting. However, diagnostic accuracy is reduced in patients with CABG. This could be due to different flow and perfusion kinetic. Further studies are needed to optimize the clinical protocols especially in post-surgical patients.
Authors: Peter Bernhardt; Sascha Stiller; Eva Kottmair; Ludwig Binner; Jochen Spiess; Georg Grossmann; Volker Rasche; Daniel Walcher; Vinzenz Hombach Journal: Int J Cardiovasc Imaging Date: 2010-10-19 Impact factor: 2.357
Authors: Michael Salerno; Angela Taylor; Yang Yang; Sujith Kuruvilla; Michael Ragosta; Craig H Meyer; Christopher M Kramer Journal: Circ Cardiovasc Imaging Date: 2014-04-23 Impact factor: 7.792
Authors: Sebastian Kelle; Kristof Graf; Stefan Dreysse; Bernhard Schnackenburg; Eckart Fleck; Christoph Klein Journal: J Cardiovasc Magn Reson Date: 2010-05-13 Impact factor: 5.364
Authors: Paolo Izzo; Andrea Macchi; Luisa De Gennaro; Antonio Gaglione; Matteo Di Biase; Natale Daniele Brunetti Journal: Eur Heart J Acute Cardiovasc Care Date: 2012-06
Authors: John F Heitner; Igor Klem; Derek Rasheed; Abhinav Chandra; Han W Kim; Lowie M R Van Assche; Michele Parker; Robert M Judd; James G Jollis; Raymond J Kim Journal: Radiology Date: 2013-12-10 Impact factor: 11.105
Authors: Andreas Seraphim; Kristopher D Knott; Anne-Marie Beirne; Joao B Augusto; Katia Menacho; Jessica Artico; George Joy; Rebecca Hughes; Anish N Bhuva; Ryo Torii; Hui Xue; Thomas A Treibel; Rhodri Davies; James C Moon; Daniel A Jones; Peter Kellman; Charlotte Manisty Journal: J Cardiovasc Magn Reson Date: 2021-06-17 Impact factor: 5.364