Prognostic Value of Normal Adenosine-Stress Cardiac Magnetic Resonance Imaging

Pilz, Guenter; Jeske, Andrea; Klos, Markus; Ali, Eman; Hoefling, Berthold; Scheck, Roland; Bernhardt, Peter

doi:10.1016/j.amjcard.2008.01.019

Cited by 81 publications

(45 citation statements)

References 20 publications

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“…2. Eventually, 11 studies [5,6,8,[18][19][20][21][22][23][24][25] fulfilled all inclusion criteria and were eligible for meta-analysis. All eligible studies had been published in peer-reviewed journals between 2004 and 2011.…”

Section: Search Resultsmentioning

confidence: 99%

“…Three studies evaluated both stress cine MRI and stress p-MRI in the same patient groups [6,21,22]. Five studies reported data on both hard cardiac events and MACE [5,6,8,18,23], three studies hard cardiac events only [19,22,24], and three studies MACE only [20,21,25]. Methodological quality assessment by NOS was 5-6 stars (Table 1).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…These patients were followed for 0.8 to 6.2 years (Table 1). For prognostic utility, six studies evaluated stress cine MRI [5,6,8,19,[21][22] and seven studies evaluated stress p-MRI [6,18,20,[22][23][24][25]. Three studies evaluated both stress cine MRI and stress p-MRI in the same patient groups [6,21,22].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Prognostic value of negative result in stress p-MRI for predicting hard cardiac events There were five studies assessing the prognostic value of stress p-MRI for hard cardiac events (Table 5) [6,18,[22][23][24]. These patients were followed for 1.0 to 5.3 years to check for the occurrence of hard cardiac events.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

Iwata

Nakagawa

Ogasawara

2014

Journal of Computer Assisted Tomography

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None of the authors have any conflicts of interest associated with this study. Abstract ObjectivesThe purpose of our study was to determine the prognostic value of normal stress cardiovascular MRI (CMR) by a systematic literature review and meta-analysis. MethodsA comprehensive literature search of published studies through November 2011 in MEDLINE database and Cochrane Library, regarding prognostic value of stress CMR in patients with known or suspected coronary artery disease (CAD), was performed. ResultsUltimately, we identified 11 studies. The summary relative risk ratio for major adverse cardiac events (MACE) was 0.50 (95% confidence interval (CI): 0.44 to 0.58) for normal cine CMR and 0.09 (95% CI: 0.02 to 0.35) for normal perfusion CMR. The summary relative risk ratio for hard cardiac events was 0.36 (95% CI: 0.16 to 0.8) for normal cine CMR and 0.22 (95% CI: 0.07 to 0.66) for normal perfusion CMR. ConclusionNormal stress CMR for patients known or suspected of having CAD has good prognostic value in predicting cardiac events.

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Section: Search Resultsmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

Iwata

Nakagawa

Ogasawara

2014

Journal of Computer Assisted Tomography

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“…It was concluded that adenosine-stress CMR imaging is a safe procedure early after acute STEMI and identifies patients with significant coronary stenosis more accurately than conventional exercise tolerance testing. Pilz et al [41] recently showed that a normal adenosine stress CMR predicted a very low cardiac event rate and an excellent 1-year prognosis in 128 patients with suspected coronary artery disease. Adenosine-stress CMR imaging may therefore serve as a reliable noninvasive gatekeeper in reducing the number of redundant coronary angiographies.…”

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confidence: 99%

Pharmacological stress: a useful exercise?

Wall

2009

Int J Cardiovasc Imaging

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Comprehensive adenosine stress perfusion MRI defines the etiology of chest pain in the emergency room: Comparison with nuclear stress test

Vogel‐Claussen

Skrok

Dombroski

et al. 2009

Magnetic Resonance Imaging

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Purpose-To compare standard of care nuclear SPECT imaging with cardiac magnetic resonance imaging (MRI) for emergency room (ER) patients with chest pain and intermediate probability for coronary artery disease.Materials and Methods-Thirty-one patients with chest pain, negative electrocardiogram (ECG), and negative cardiac enzymes who underwent cardiac single photon emission tomography (SPECT) within 24 h of ER admission were enrolled. Patients underwent a comprehensive cardiac MRI exam including gated cine imaging, adenosine stress and rest perfusion imaging and delayed enhancement imaging. Patients were followed for 14 ± 4.7 months.Results-Of 27 patients, 8 (30%) showed subendocardial hypoperfusion on MRI that was not detected on SPECT. These patients had a higher rate of diabetes (P = 0.01) and hypertension (P = 0.01) and a lower global myocardial perfusion reserve (P = 0.01) compared with patients with a normal cardiac MRI (n = 10). Patients with subendocardial hypoperfusion had more risk factors for cardiovascular disease (mean 4.4) compared with patients with a normal MRI (mean 2.5; P = 0.005). During the follow-up period, patients with subendocardial hypoperfusion on stress MRI were more likely to return to the ER with chest pain compared with patients who had a normal cardiac MRI (P = 0.02). Four patients did not finish the MR exam due to claustrophobia.Conclusion-In patients with chest pain, diabetes and hypertension, cardiac stress perfusion MRI identified diffuse subendocardial hypoperfusion defects in the ER setting not seen on cardiac SPECT, which is suspected to reflect microvascular disease. Keywordsadenosine stress perfusion cardiac MRI; emergency room; chest pain; microvascular disease The evaluation and triage of patients with chest pain is a common challenge for emergency room (ER) physicians. Fast and accurate assessment of myocardial ischemia in a patient * Address reprint requests to: J.V.-C., Johns Hopkins University, Department of Radiology, Nelson Basement MRI 143, 600 N Wolfe Street, Baltimore, MD 21287. jclauss1@jhmi.edu. New technical developments over the past decade allow a comprehensive cardiac MRI examination, which includes myocardial perfusion, function, and viability assessment (4,5). Stress perfusion with MRI is an emerging noninvasive method for the evaluation of myocardial ischemia (6-9). Myocardial scar imaging with MRI aids in identifying small subendocardial myocardial infarctions that are not seen by cardiac SPECT (10). Furthermore, cardiac SPECT exposes the patient to 17-20 mSv of ionizing radiation (11) that is not present with MRI. NIH Public AccessSome patients presenting to the ER with chest pain likely of cardiac origin may not have flow limiting stenosis of the coronary arteries, but instead have small vessel or other cardiac disease that could potentially be identified by . Therefore, the aim of this study was to compare standard of care nuclear SPECT imaging with cardiac MRI for the evaluation of emergency room patients with chest pain and intermediate pr...

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Prognostic Value of Normal Adenosine-Stress Cardiac Magnetic Resonance Imaging

Cited by 81 publications

References 20 publications

The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

Pharmacological stress: a useful exercise?

Comprehensive adenosine stress perfusion MRI defines the etiology of chest pain in the emergency room: Comparison with nuclear stress test

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