Diagnostic Accuracy of Adenosine Stress Cardiovascular Magnetic Resonance Following Acute ST-segment Elevation Myocardial Infarction Post Primary Angioplasty

Journal of Cardiovascular Magnetic Resonance

Research

Dennis TL Wong¹  Matthew I Worthley¹  Stephen G Worthley¹  Kerry Williams¹  Payman Molaee¹  Karen SL Teo¹  Rajiv Das¹  Gary YH Liew¹  Benjamin K Dundon¹  Michael CH Leung²  Ian T Meredith² 

[1] Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia;Monash Cardiovascular Research Centre, Department of Medicine (MMC), MonashUniversity, and MonashHeart, Melbourne, Australia;

关键词: Percutaneous Coronary Intervention;    Cardiovascular Magnetic Resonance;    Late Gadolinium Enhancement;    Primary Percutaneous Coronary Intervention;    Diagnostic Odds Ratio;   

DOI  :  10.1186/1532-429X-13-62

 received in 2011-05-11, accepted in 2011-10-22,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundAdenosine stress cardiovascular magnetic resonance (CMR) has been proven an effective tool in detection of reversible ischemia. Limited evidence is available regarding its accuracy in the setting of acute coronary syndromes, particularly in evaluating the significance of non-culprit vessel ischaemia. Adenosine stress CMR and recent advances in semi-quantitative image analysis may prove effective in this area. We sought to determine the diagnostic accuracy of semi-quantitative versus visual assessment of adenosine stress CMR in detecting ischemia in non-culprit territory vessels early after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).MethodsPatients were prospectively enrolled in a CMR imaging protocol with rest and adenosine stress perfusion, viability and cardiac functional assessment 3 days after successful primary-PCI for STEMI. Three short axis slices each divided into 6 segments on first pass adenosine perfusion were visually and semi-quantitatively analysed. Diagnostic accuracy of both methods was compared with non-culprit territory vessels utilising quantitative coronary angiography (QCA) with significant stenosis defined as ≥70%.ResultsFifty patients (age 59 ± 12 years) admitted with STEMI were evaluated. All subjects tolerated the adenosine stress CMR imaging protocol with no significant complications. The cohort consisted of 41% anterior and 59% non anterior infarctions. There were a total of 100 non-culprit territory vessels, identified on QCA. The diagnostic accuracy of semi-quantitative analysis was 96% with sensitivity of 99%, specificity of 67%, positive predictive value (PPV) of 97% and negative predictive value (NPV) of 86%. Visual analysis had a diagnostic accuracy of 93% with sensitivity of 96%, specificity of 50%, PPV of 97% and NPV of 43%.ConclusionAdenosine stress CMR allows accurate detection of non-culprit territory stenosis in patients successfully treated with primary-PCI post STEMI. Semi-quantitative analysis may be required for improved accuracy. Larger studies are however required to demonstrate that early detection of non-culprit vessel ischemia in the post STEMI setting provides a meaningful test to guide clinical decision making and ultimately improved patient outcomes.

【 授权许可】

Unknown   
© Wong et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.