Impact of arrhythmia on diagnostic performance of adenosine stress CMR in patients with suspected or known coronary artery disease

Abstract

BackgroundThe diagnostic performance of adenosine stress cardiovascular magnetic resonance (CMR) in patients with arrhythmias presenting for work-up of suspected or known CAD is largely unknown, since most CMR studies currently available exclude arrhythmic patients from analysis fearing gating problems, or other artifacts will impair image quality. The primary aim of our study was to evaluate the diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for 1) work-up of suspected coronary artery disease (CAD), or 2) work-up of ischemia in known CAD.MethodsPatients with arrhythmia referred for work-up of suspected CAD or work-up of ischemia in known CAD undergoing adenosine stress CMR were included if they had coronary angiography within four weeks of CMR.ResultsOne hundred fifty-nine patients were included (n = 64 atrial fibrillation, n = 87 frequent ventricular extrasystoles, n = 8 frequent supraventricular extrasystoles). Of these, n = 72 had suspected CAD, and n = 87 had known CAD. Diagnostic accuracy of the adenosine stress CMR for detection of significant CAD was 73 % for the entire population (sensitivity 72 %, specificity 76 %). Diagnostic accuracy was 75 % (sensitivity 80 %, specificity 74 %) in patients with suspected CAD, and 74 % (sensitivity 71 %, specificity 79 %) in the group with known CAD. For different types of arrhythmia, diagnostic accuracy of CMR was 70 % in the atrial fibrillation group, and 79 % in patients with ventricular extrasystoles. On a per coronary territory analysis, diagnostic accuracy of CMR was 77 % for stenosis of the left and 82 % for stenosis of the right coronary artery.ConclusionThe present data demonstrates good diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for work-up of suspected CAD, or work-up of ischemia in known CAD. This holds true for a per patient, as well as for a per coronary territory analysis.

Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation

“…Nevertheless, adenosine stress CMR remains an accurate clinical investigation in patients with AF,24 and RPP should not be used to demonstrate adequacy of adenosine stress because the coronary hyperemic effects of adenosine are largely independent of changes in hemodynamics 16. Rates of splenic switch‐off, a validated technique for excluding inadequate stress,14 were high and similar between groups in our study.…”

Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation

“…The overall diagnostic accuracy of 96% compares favorably with that in previously published CMR perfusion imaging studies in patients without arrhythmia[2–4, 8]. Greulich et al recently report results in 64 patients with AF using a standard stress-first, ECG-gated perfusion CMR protocol[10]. They report a sensitivity of 71%, specificity of 69%, and accuracy of 70%.…”

“…In addition, the readers in the current study do not view any cine or LGE images during image analysis. This is in contrast to the Greulich study and others[2–4, 10] where cine and LGE images are analyzed with the perfusion CMR. Thus, the data presented here does not account for the further diagnostic benefit that cine and LGE images may provide.…”

“…Although multiple studies have shown sensitivity and specificity of perfusion CMR for obstructive CAD greater than 80%,[2–4, 8, 9] diagnostic accuracy of this modality has received little study in patients with AF. Greulich et al recently reported a diagnostic accuracy of 70% in 64 patients with AF using a standard ECG-gated breath-hold perfusion CMR protocol[10]. This suggests that diagnostic accuracy of conventional perfusion CMR may be reduced in patients with AF.…”

Review of Journal of Cardiovascular Magnetic Resonance 2015

“…This study evaluated the influence of arrhythmias on the diagnostic performance of adenosine stress CMR [106]. Of the 159 patient enrolled, 72 had suspected CAD and 87 had known CAD.…”