POSTER PRESENTATION Open Access

Incremental value of cardiac magnetic resonancewith adenosine stress perfusion in coronaryartery disease detectionEulalia Pereira1, Nuno Bettencourt1*, Nuno D Ferreira1, Andreas Schuster2, Amedeo Chiribiri2, João Primo1,Madalena Teixeira1, Lino Simões1, Eike Nagel2, Vasco Gama1

From 16th Annual SCMR Scientific SessionsSan Francisco, CA, USA. 31 January - 3 February 2013

BackgroundA multiple-test strategy in often needed in the evaluationof patients (pts) with suspected coronary artery disease(CAD). Cardiac magnetic resonance (CMR) has potentialadvantages in this context allowing simultaneous evalua-tion of ventricular function, myocardial perfusion and scardetection with high spatial resolution and no ionizingradiation exposure. We aimed to compare the diagnosticaccuracy of adenosine stress CMR myocardial perfusionimaging (CMR-MPI) with exercise treadmill test (ETT) fordetection of CAD using invasive fractional flow reserve(FFR) as the reference standard, and to assess the best per-forming diagnostic algorithm using these tests in patientswith suspected CAD.

MethodsProspective single-center study with enrollment of symp-tomatic pts referred to cardiology to suspected CADassessment. All pts underwent a sequential protocolincluding: ETT, CMR-MPI and X-ray coronary angiogra-phy (XA). The ETT was dichotomously classified anddeemed suggestive of CAD if reproduction of clinicalsymptoms during effort or additional ST-segmentdepression ≥1 mm. CMR-MPI exams were evaluated bytwo independent cardiologists blinded to the results ofETT. Functionally significant CAD was defined by thepresence of occlusive/sub-occlusive stenosis or FFR mea-surements <0.8 in vessels >2 mm. Multiples protocolsintegrating ETT and CMR-MPI were tested using ROCcurves.

Results80 pts were recruited, 68% male and with mean age of61 ± 8 years. All pts were symptomatic and had at leastone cardiovascular risk factor. CAD was detected in 37pts (47%). CMR-MPI and ETT showed similar sensitivityfor CAD detection (81 vs. 80%), but with higher specifi-city for CMR-MPI (93 vs. 56%), translating into a greaterdiagnostic accuracy of CMR-MPI (AUC=0.87 vs. 0.70;PPV=91 vs. 58%). In the best performing protocol (AUC= 0.83), pts with both clinical and electrically positiveETT would be directly referred to XA while all theremaining pts (negative, borderline positive or inconclu-sive ETT) would be managed according to CMR-MPIresults. The other protocols, including referral to CMR-MPI only the pts with borderline positive or inconclusiveETT or with negative or inconclusive ETT had worstperformances (AUC=0.75 and 0.73, respectively).

ConclusionsCMR-MPI has high sensitivity and specificity for detectionof obstructive CAD. In our pts with high probability ofCAD, the inclusion of CMR-MPI in an integrated protocolfor the detection of CAD improved the overall diagnosticaccuracy, particularly in those pts with negative, borderlinepositive or inconclusive ETT.

FundingNo conflict of interests/financial disclosures.

Author details1Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Novade Gaia, Portugal. 2Kings College London, London, UK.

Published: 30 January 2013

1Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Novade Gaia, PortugalFull list of author information is available at the end of the article

Pereira et al. Journal of Cardiovascular MagneticResonance 2013, 15(Suppl 1):E57http://www.jcmr-online.com/content/15/S1/E57

© 2013 Pereira et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.

doi:10.1186/1532-429X-15-S1-E57Cite this article as: Pereira et al.: Incremental value of cardiac magneticresonance with adenosine stress perfusion in coronary artery diseasedetection. Journal of Cardiovascular Magnetic Resonance 201315(Suppl 1):E57.

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Pereira et al. Journal of Cardiovascular MagneticResonance 2013, 15(Suppl 1):E57http://www.jcmr-online.com/content/15/S1/E57

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