CMR and detection of coronary artery disease

2021 ◽  
pp. 447-466
Author(s):  
Eike Nagel ◽  
Juerg Schwitter ◽  
Sven Plein
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Diagnostic Performance ◽  
Reliable Technique ◽  
Artery Disease ◽  
Ischaemia Detection ◽  
Perfusion Cmr ◽  
Cmr Imaging

Cardiovascular magnetic resonance (CMR) imaging plays a major role in the diagnosis and assessment of coronary artery disease (CAD). This chapter will focus on the diagnosis of ischaemia by CMR with brief reference to viability assessment, which is covered in detail elsewhere. Perfusion-CMR has matured to a reliable technique for the assessment of CAD. It detects and excludes CAD with a high diagnostic performance. There is also increasing evidence from single-centre studies and the European CMR registry for the high prognostic value of ischaemia detection by perfusion-CMR and a normal CMR study in patients with or without known CAD predicts a rate for MACE of 0.3–1%/year. Coronary angiography by CMR will not be discussed in this chapter, however, as it is only recommended for delineation of the course of coronary artery anomalies.

scholarly journals Cardiovascular magnetic resonance accurately detects obstructive coronary artery disease in suspected non-ST elevation myocardial infarction: a sub-analysis of the CARMENTA Trial

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Yvonne J. M. van Cauteren ◽  
Martijn W. Smulders ◽  
Ralph A. L. J. Theunissen ◽  
Suzanne C. Gerretsen ◽  
Bouke P. Adriaans ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Stress Perfusion ◽  
St Elevation ◽  
Artery Disease ◽  
Sensitivity Specificity ◽  
Perfusion Cmr

Abstract Background Invasive coronary angiography (ICA) is still the reference test in suspected non-ST elevation myocardial infarction (NSTEMI), although a substantial number of patients do not have obstructive coronary artery disease (CAD). Early cardiovascular magnetic resonance (CMR) may be a useful gatekeeper for ICA in this setting. The main objective was to investigate the accuracy of CMR to detect obstructive CAD in NSTEMI. Methods This study is a sub-analysis of a randomized controlled trial investigating whether a non-invasive imaging-first strategy safely reduced the number of ICA compared to routine clinical care in suspected NSTEMI (acute chest pain, non-diagnostic electrocardiogram, high sensitivity troponin T > 14 ng/L), and included 51 patients who underwent CMR prior to ICA. A stepwise approach was used to assess the diagnostic accuracy of CMR to detect (1) obstructive CAD (diameter stenosis ≥ 70% by ICA) and (2) an adjudicated final diagnosis of acute coronary syndrome (ACS). First, in all patients the combination of cine, T2-weighted and late gadolinium enhancement (LGE) imaging was evaluated for the presence of abnormalities consistent with a coronary etiology in any sequence. Hereafter and only when the scan was normal or equivocal, adenosine stress-perfusion CMR was added. Results Of 51 patients included (63 ± 10 years, 51% male), 34 (67%) had obstructive CAD by ICA. The sensitivity, specificity and overall accuracy of the first step to diagnose obstructive CAD were 79%, 71% and 77%, respectively. Additional vasodilator stress-perfusion CMR was performed in 19 patients and combined with step one resulted in an overall sensitivity of 97%, specificity of 65% and accuracy of 86%. Of the remaining 17 patients with non-obstructive CAD, 4 (24%) had evidence for a myocardial infarction on LGE, explaining the modest specificity. The sensitivity, specificity and overall accuracy to diagnose ACS (n = 43) were 88%, 88% and 88%, respectively. Conclusion CMR accurately detects obstructive CAD and ACS in suspected NSTEMI. Non-obstructive CAD is common with CMR still identifying an infarction in almost one-quarter of patients. CMR should be considered as an early diagnostic approach in suspected NSTEMI. Trial registration. The CARMENTA trial has been registered at ClinicalTrials.gov with identifier NCT01559467.

P5257Prediction of 12-month cardiovascular event-free survival with regadenoson perfusion cardiovascular magnetic resonance

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Weiss ◽  
P Behm ◽  
M Gastl ◽  
M Kelm ◽  
F Boenner
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Cardiovascular Events ◽  
Event Free Survival ◽  
Free Survival ◽  
Artery Disease ◽  
Perfusion Cmr

Abstract Background To identify and stratify coronary artery disease (CAD) non-invasively, cardiovascular magnetic resonance (CMR) derived perfusion imaging holds a class Ia recommendation. As Gold standard, hyperemia is induced by an intravenous application of adenosine in a body weight adapted dosage over a constant time. However, adenosin has two disadvantages: 1.) efficacy of adenosine to induce maximal hyperemia via peripheral line is imperfect and 2.) additional adenosine specific effects exclude patients having comorbidities (e.g. AV-blocks and obstructive lung disease). Fortunately, regadenoson as aselective A2A-receptor agonist has the main advantages of being easier to handle (bolus application) and to be not restricted to patients without specific comorbidities. However, there is a lack of comprehensive data on the prognostic value of regadenoson perfusion CMR to predict clinical endpoints. To assess the predictive value of regadenoson perfusion CMR, our hypothesis was, that a “negative” ischemia test result by regadenoson-CMR predicted freedom from MACE at 12 month. Methods 676 patients, with known or suspected CAD with intermediate risk were retrospectively analyzed from May 2015 till December 2016. Cardiovascular risk factors (CVRF) like age, sex, arterial hypertension, dis-/hyperlipidemia, cigarette smoking status and diabetes were documented. All included patients received perfusion CMR (Philips 1.5 Tesla) with regadenoson (0.4 mg) and a positive ischemia test was defined as perfusion defects in ≥1,5 cardiac segments (using the 17-segment model). Major cardiovascular events (MACE) were defined as cardiovascular death, rehospitalisation due to myocardial infarction and rehospitalisation due to revascularization. The follow-up time was 12 month. Results 80,3% (n=543) of all analyzed patients showed negative ischemia testing in CMR and were thus followed up for 12 month. From these patients, 284 (52,3%) had a pre-existing coronary artery disease. The mean age regarding only the patients with negative ischemia was 66 years (65% male and 35% female) with 1,35±1,03 CVRF. The primary endpoint (MACE) occurred in 6 patients (1,1%): 3 (0,6%) died due to cardiovascular events, 1 (0,2%) suffered from a myocardial infarction and 2 (0,4%) received coronary revascularization. Consequently, an event-free survival was correctly predicted in 98,9% of all patients. No undesirable adverse reactions have appeared. Conclusion Regadenoson-CMR predicts a very low MACE-rate and an event-free survival in 98,9% in over 500 patients. In our study, Regadenoson was well tolerated and no side effects were reported.

Prognostic value of dipyridamole stress perfusion cardiovascular magnetic resonance in elderly patients >75 years with suspected coronary artery disease

2020 ◽  
Author(s):  
Théo Pezel ◽  
Francesca Sanguineti ◽  
Marine Kinnel ◽  
Thomas Hovasse ◽  
Philippe Garot ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Stress Perfusion ◽  
Artery Disease ◽  
Stress Cmr ◽  
Dipyridamole Stress

Abstract Aims  There are only very few data on the prognostic value of stress cardiovascular magnetic resonance (CMR) in elderly people, while life expectancy of the general population is steadily increasing. Therefore, this study aims to assess the prognostic value of vasodilator stress perfusion CMR in elderly >75 years. Methods and results  Between 2008 and 2017, we included consecutive elderly >75 years without known coronary artery disease (CAD) referred for dipyridamole stress CMR. They were followed for the occurrence of major adverse cardiovascular events (MACE) including cardiac death or non-fatal myocardial infarction. Univariate and multivariate analyses were performed to determine the prognostic value of ischaemia or late gadolinium enhancement. Of 754 elderly individuals (82.0 ± 3.9 years, 48.4% men), 659 (87.4%) completed the follow-up with median follow-up of 4.7 years. Using Kaplan–Meier analysis, the presence of myocardial ischaemia was associated with the occurrence of MACE [hazard ratio (HR) 5.38, 95% confidence interval (CI): 3.56–9.56; P < 0.001]. In a multivariable Cox regression including clinical characteristics and CMR indexes, inducible ischaemia was an independent predictor of a higher incidence of MACE (HR 4.44, 95% CI: 2.51–7.86; P < 0.001). In patients without ischaemia, the occurrence of MACE was lower in women when compared with men (P < 0.01). Conclusion  Stress CMR is safe and has discriminative prognostic value in elderly, with a significantly lower event rate of future cardiovascular event or death in subjects without ischaemia or infarction.

scholarly journals Prognostic value of resting coronary sinus flow determined by phase-contrast cine cardiovascular magnetic resonance in patients with known or suspected coronary artery disease

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shingo Kato ◽  
Kazuki Fukui ◽  
Sho Kodama ◽  
Mai Azuma ◽  
Naoki Nakayama ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Coronary Sinus ◽  
Prognostic Value ◽  
Phase Contrast ◽  
Suspected Coronary Artery Disease ◽  
Non Invasive ◽  
Invasive Method ◽  
Artery Disease

Abstract Background Phase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to measure coronary sinus blood flow (CSBF) and coronary flow reserve (CFR). We aimed to compare the prognostic value of resting CSBF and CFR for predicting major adverse cardiac events (MACE) in patients with known or suspected coronary artery disease (CAD) who underwent vasodilator stress CMR. Methods We studied 693 patients with known CAD and 519 patients with suspected CAD admitted to our hospital between 2009 and 2019. The CFR was calculated as the CSBF during adenosine triphosphate infusion divided by CSBF at rest. MACE was defined as composite of cardiovascular death, acute coronary syndrome, heart failure hospitalization, and sustained ventricular tachyarrhythmia. Results During a median follow-up of 4.6 years, 92 patients (8%) experienced MACE. The resting CSBF was significantly higher in patients with MACE than in patients without MACE (114.7 ± 44.9 mL/min vs. 84.7 ± 30.9 mL/min, p < 0.001 for known CAD; 122.2 ± 33.3 mL/min vs. 86.6 ± 36.7 mL/min, p < 0.001 for suspected CAD). The resting CSBF remained a significant predictor for MACE after adjusting clinical and CMR variables (hazard ratio [HR] of resting CSBF higher than the median: 3.18, p = 0.0083 for known CAD; HR: 23.3, p < 0.001 for suspected CAD). The area under the curve for predicting MACE was 0.73 for resting CSBF, 0.72 for CFR (p = 0.78) in patients with known CAD, and 0.82 for resting CSBF, 0.83 (p = 0.58) for CFR in patients with suspected CAD. Conclusions The resting CSBF may be a useful non-invasive method for the risk stratification of patients with known or suspected CAD without any radiation exposure, contrast media, or pharmacological vasodilator agents.

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