PURPOSE: To compare Cardiovascular Magnetic Resonance (CMR) with coronaryangiography (CA) in patients with suspected coronary artery disease (CAD).
METHODS: We studied 30 consecutive patients (26 males) with suspected CAD that underwent CRM (Feb/04 to Jan/07). All examinations were performed with a 1.5-T imager. “Fast Imaging with Steady-state free Precession” (true-FISP) sequences were used to evaluate myocardial function and perfusion. The detection of late myocardial gadolinium-enhancement was depicted with inversion recovery gradient echo sequences after administration of double dose of contrast. End diastolic volume, left ventricular (LV) mass and ejection fraction were calculated in all patients. Myocardium perfusion using gadolinium was evaluated during pharmacological stress (end of 4th minute of adenosine perfusion) and 15 minutes after (rest), in 28 patients. Whenever the coronariography was performed (18 patients), it was compared with CMR.
RESULTS: Mean LV volume was 180.8±50.1 ml. LV mass was increased in 6 patients, one of which with known hypertrophic cardiomyopathy. Mean ejection fraction was 60.7%. Perfusion defects compatible with myocardial ischemia were detected in 14 patients (group A) with pharmacological stress CMR. In the remaining 16 (group B), 4 patients had evidence of necrosis. CA was performed in 18 patients (13 of the group A and 5 of group B). In group A patients submitted to CA, 9 had significant coronary stenosis and one had hypertrophic cardiomyopathy. In group B patients, CA was negative in 2 of them and showed coronary stenosis in 3 (in necrotic territory, as already objectivated by CMR). Regarding the coronary territories, the CMR was correct in 83% of cases with significant coronary stenosis (overestimated in 4 patients). There were three false positives (25%) and none false negatives.
CONCLUSION: The CMR seems to be accurate in excluding and diagnosing (which can be overestimated by this method), thus representing a valid non-invasive alternative to CA in CAD patients.
CLINICAL IMPLICATIONS: The CMR is a noninvasive imaging method with an increasing importance in cardiology. However, there are only few studies that evaluate its role in myocardial ischemia.
DISCLOSURE: Natalia Antonio, No Financial Disclosure Information; No Product/Research Disclosure Information