PURPOSE: To compare the utility and efficacy of stress cardiac magnetic resonance (MR) imaging and stress echocardiography in an emergency setting in patients with acute chest pain (CP) and intermediate risk of coronary artery disease (CAD). MATERIALS AND METHODS: Written informed consent was obtained from all patients. This HIPAA-compliant study was approved by the institutional review board for research ethics. Sixty patients without history of CAD presented to the emergency department with intermediate-risk acute CP and were prospectively enrolled. Patients underwent both stress cardiac MR imaging and stress echocardiography in random order within 12 hours of presentation. Stress imaging results were interpreted clinically immediately (blinded interpretation was performed months later), and coronary angiography was performed if either result was abnormal. CAD was considered significant if it was identified at angiography (narrowing >50% ) or if a cardiac event (death or myocardial infarction) occurred during follow-up (mean, 14 months ± 5 [standard deviation]). McNemar test was used to compare the diagnostic accuracy of techniques. RESULTS: Stress cardiac MR imaging and stress echocardiography had similar specificity, accuracy, and positive and negative predictive values (92% vs 96%, 93% vs 88%, 67% vs 60%, and 100% vs 91%, respectively, for clinical interpretation; 90% vs 92%, 90% vs 88%, 58% vs 56%, and 98% vs 94%, respectively, for blinded interpretation). Stress cardiac MR imaging had higher sensitivity at clinical interpretation (100% vs 38%, P = .025), which did not reach significance at blinded interpretation (88% vs 63%, P = .31). However, multivariable logistic regression analysis showed stress cardiac MR imaging to be the strongest independent predictor of significant CAD (P = .002). CONCLUSION: In patients presenting to the emergency department with intermediate-risk CP, adenosine stress cardiac MR imaging performed within 12 hours of presentation is safe and potentially has improved performance characteristics compared with stress echocardiography. Online supplemental material is available for this article. RSNA, 2013
PURPOSE: To compare the utility and efficacy of stress cardiac magnetic resonance (MR) imaging and stress echocardiography in an emergency setting in patients with acute chest pain (CP) and intermediate risk of coronary artery disease (CAD). MATERIALS AND METHODS: Written informed consent was obtained from all patients. This HIPAA-compliant study was approved by the institutional review board for research ethics. Sixty patients without history of CAD presented to the emergency department with intermediate-risk acute CP and were prospectively enrolled. Patients underwent both stress cardiac MR imaging and stress echocardiography in random order within 12 hours of presentation. Stress imaging results were interpreted clinically immediately (blinded interpretation was performed months later), and coronary angiography was performed if either result was abnormal. CAD was considered significant if it was identified at angiography (narrowing >50% ) or if a cardiac event (death or myocardial infarction) occurred during follow-up (mean, 14 months ± 5 [standard deviation]). McNemar test was used to compare the diagnostic accuracy of techniques. RESULTS:Stress cardiac MR imaging and stress echocardiography had similar specificity, accuracy, and positive and negative predictive values (92% vs 96%, 93% vs 88%, 67% vs 60%, and 100% vs 91%, respectively, for clinical interpretation; 90% vs 92%, 90% vs 88%, 58% vs 56%, and 98% vs 94%, respectively, for blinded interpretation). Stress cardiac MR imaging had higher sensitivity at clinical interpretation (100% vs 38%, P = .025), which did not reach significance at blinded interpretation (88% vs 63%, P = .31). However, multivariable logistic regression analysis showed stress cardiac MR imaging to be the strongest independent predictor of significant CAD (P = .002). CONCLUSION: In patients presenting to the emergency department with intermediate-risk CP, adenosinestress cardiac MR imaging performed within 12 hours of presentation is safe and potentially has improved performance characteristics compared with stress echocardiography. Online supplemental material is available for this article. RSNA, 2013
Authors: J H Pope; T P Aufderheide; R Ruthazer; R H Woolard; J A Feldman; J R Beshansky; J L Griffith; H P Selker Journal: N Engl J Med Date: 2000-04-20 Impact factor: 91.245
Authors: T H Marwick; C Case; S Sawada; C Rimmerman; P Brenneman; R Kovacs; L Short; M Lauer Journal: J Am Coll Cardiol Date: 2001-03-01 Impact factor: 24.094
Authors: L K Newby; A B Storrow; W B Gibler; J L Garvey; J F Tucker; A L Kaplan; D H Schreiber; R H Tuttle; S E McNulty; E M Ohman Journal: Circulation Date: 2001-04-10 Impact factor: 29.690
Authors: Howard Leong-Poi; Se-Joong Rim; D Elizabeth Le; Nick G Fisher; Kevin Wei; Sanjiv Kaul Journal: Circulation Date: 2002-02-26 Impact factor: 29.690
Authors: Raymond Y Kwong; Adam E Schussheim; Suresh Rekhraj; Anthony H Aletras; Nancy Geller; Janice Davis; Timothy F Christian; Robert S Balaban; Andrew E Arai Journal: Circulation Date: 2003-02-04 Impact factor: 29.690
Authors: John F Heitner; Raymond J Kim; Han W Kim; Igor Klem; Dipan J Shah; Dany Debs; Afshin Farzaneh-Far; Venkateshwar Polsani; Jiwon Kim; Jonathan Weinsaft; Chetan Shenoy; Andrew Hughes; Preston Cargile; Jean Ho; Robert O Bonow; Elizabeth Jenista; Michele Parker; Robert M Judd Journal: JAMA Cardiol Date: 2019-03-01 Impact factor: 14.676
Authors: Giovanni Di Leo; Erica Fisci; Francesco Secchi; Marco Alì; Federico Ambrogi; Luca Maria Sconfienza; Francesco Sardanelli Journal: Eur Radiol Date: 2015-12-11 Impact factor: 5.315
Authors: Yvonne J M van Cauteren; Martijn W Smulders; Ralph A L J Theunissen; Suzanne C Gerretsen; Bouke P Adriaans; Geertruida P Bijvoet; Alma M A Mingels; Sander M J van Kuijk; Simon Schalla; Harry J G M Crijns; Raymond J Kim; Joachim E Wildberger; Jordi Heijman; Sebastiaan C A M Bekkers Journal: J Cardiovasc Magn Reson Date: 2021-03-22 Impact factor: 5.364