Clinical implication of adenosine-stress cardiac magnetic resonance imaging as potential gatekeeper prior to invasive examination in patients with AHA/ACC class II indication for coronary angiography

Pilz, Guenter; Bernhardt, Peter; Klos, Markus; Ali, Eman; Wild, Michael; Höfling, B.

doi:10.1007/s00392-006-0422-7

Cited by 56 publications

(31 citation statements)

References 28 publications

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“…24,25 However, these studies included patients with chest pain or clinical features of CAD; therefore, a comparison with our study is not strictly valid. Pilz et al 26 have also used a "gatekeeper" model to argue for a role for adenosine stress CMR in a different cohort of patients with a class II indication for CA. Their data show that the rates of CA in this cohort who have an intermediate probability of CAD could be reduced by Ͼ80%.…”

Section: Discussionmentioning

confidence: 99%

Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology

et al. 2011

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Background-In patients presenting with new-onset heart failure of uncertain etiology, the role of coronary angiography (CA) is unclear. Although conventionally performed to differentiate underlying coronary artery disease from dilated cardiomyopathy, CA is associated with a risk of complications and may not detect an ischemic cause resulting from arterial recanalization or an embolic episode. In this study, we assessed the diagnostic accuracy of a cardiovascular magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) and magnetic resonance CA as a noninvasive gatekeeper to CA in determining the etiology of heart failure in this subset of patients. Methods and Results-One hundred twenty consecutive patients underwent CMR and CA. The etiology was ascribed by a consensus panel that used the results of the CMR scans. Similarly, a separate consensus group ascribed an underlying cause by using the results of CA. The diagnostic accuracy of both strategies was compared against a gold-standard panel that made a definitive judgment by reviewing all clinical data. The study was powered to show noninferiority between the 2 techniques. The sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for LGE-CMR were equivalent to CA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). As a gatekeeper to CA, LGE-CMR was also found to be a cheaper diagnostic strategy in a decision tree model when United Kingdom-based costs were assumed. The economic merits of this model would change, depending on the relative costs of LGE-CMR and CA in any specific healthcare system. Conclusion-This study showed that LGE-CMR is a safe, clinically effective, and potentially economical gatekeeper to CA in patients presenting with heart failure of uncertain etiology.

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Section: Discussionmentioning

confidence: 99%

Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology

et al. 2011

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“…For MR-PERF, they reported a sensitivity of 0.90 and a specifi city of 0.85. Pilz et al [4] published a series of 171 patients with American Heart Association Class II indication for coronary angiography, examined with MR-PERF, and reported a sensitivity of 0.96 and a specifi city of 0.83. Takase et al [5] described a population of 102 patients investigated with dipyridamole stress test and MR-PERF and reported a sensitivity of 0.93 and a specifi city of 0.85 for the detection of CAD.…”

Section: Mr-perf: Single-center Clinical Trialsmentioning

confidence: 99%

Cardiac magnetic resonance stress testing: Results and prognosis

Chiribiri

Bettencourt²,

Nagel³

2008

Curr Cardiol Rep

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Cardiac stress magnetic resonance (MR) testing has been developed and optimized in the past decade, reaching a high diagnostic performance. Its efficacy, together with its excellent safety profile and increasing availability, make cardiac stress MR testing one of the diagnostic modalities of choice for detecting ischemia. A noticeable series of studies validated the diagnosis of ischemia with MR compared with coronary angiography and other noninvasive diagnostic techniques and invasive hemodynamic measurements. In addition, first data on the usefulness of cardiac stress MR testing in assessing prognosis has become available. This article reviews the available literature about diagnostic performance of cardiac stress MR testing and its results in the prognostication of cardiac patients.

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“…Besides PET, CMR and CT MPIguided strategies prior to ICA may also lead to reduced hospital expenses. 9,10 Cardiac PET Nuclear MPI techniques are widely used and have traditionally been the preferred tool for assessment of myocardial perfusion. Nuclear imaging techniques are able to measure myocardial perfusion, viability, and function, but provide limited information regarding anatomy (Fig 1).…”

Section: Myocardial Perfusion Imagingmentioning

confidence: 99%