Key result
Normal adenosine-stress cardiac MRI demonstrated a 96.2% negative predictive value for significant coronary artery disease, increasing to 98.7% with semiquantitative perfusion analysis cutoffs.
Why the study?
Does normal adenosine-stress cardiac MRI predict the absence of significant coronary artery disease in patients referred for coronary angiography?
Observational (n=158)
Does normal adenosine-stress cardiac MRI predict the absence of significant coronary artery disease in patients referred for coronary angiography?
A normal adenosine-stress cardiac MRI has a very high negative predictive value for significant coronary artery disease, which can be further improved with semiquantitative perfusion analysis, supporting its use as a gatekeeper for coronary angiography.
May support deferring angiography after normal adenosine-stress CMR; leaves open prospective validation of semiquantitative cutoffs.
PURPOSE: To prospectively determine the negative predictive value of normal adenosine stress cardiac MR (CMR) in routine patients referred for evaluation of coronary artery disease (CAD), predominantly with intermediate to high pretest risk. MATERIALS AND METHODS: Consecutive patients referred for coronary angiography were examined in a 1.5 Tesla whole-body scanner before catheterization. A total of 158 patients with normal CMR on qualitative assessment were included, and semiquantitative perfusion analysis was performed. Significant CAD was regarded as luminal narrowing of >or=70% in coronary angiography. RESULTS: In the 158 study patients, negative predictive value of normal adenosine-stress CMR for significant CAD was 96.2% (for stenosis >or=90%: 98.1%). True-negative and false-negative patients were comparable regarding clinical presentation, risk factors, and CMR findings. Semiquantitative perfusion analysis gave significantly prolonged arrival time index and peak time index in the false-negative group. Using cutoff values >1.8 for arrival time index or >1.2 for peak time index, the CMR negative predictive value increased to 98.7% (for stenosis >or=90%: to 100%). CONCLUSION: The very high negative predictive value for CAD supports CMR-based decision making for the indication to coronary angiography. Semiquantitative perfusion analysis seems promising to identify the small group of CAD patients not detectable by qualitative CMR assessment.
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Pilz et al. (2010) conducted an observational in Coronary artery disease (CAD) (n=158). Adenosine-stress cardiac MRI (CMR) vs. Coronary angiography was evaluated on Negative predictive value for significant CAD (luminal narrowing ≥70% in coronary angiography). Normal adenosine-stress cardiac MRI demonstrated a 96.2% negative predictive value for significant coronary artery disease, increasing to 98.7% with semiquantitative perfusion analysis cutoffs.
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