The Impact of Myocardial Flow Reserve on the Detection of Coronary Artery Disease by Perfusion Imaging Methods: An NHLBI WISE Study

Doyle, Mark; Fuisz, Anthon; Kortright, Eduardo; Biederman, Robert W; Walsh, Edward G.; Martin, Edward T.; Tauxe, Lindsey; Rogers, William J.; Merz, C. Noel Bairey; Pepine, Carl J.; Sharaf, Barry L.; Pohost, Gerald M.

doi:10.1081/jcmr-120022263

Cited by 76 publications

(46 citation statements)

References 34 publications

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“…In another study, CMR myocardial perfusion reserve was found to be comparable to standard gated SPECT techniques. 142 Most recently, in a series of 1000 examinations (including 257 women) for high-dose dobutamine stress, CMR was found to have a safety profile comparable to that of high-dose dobutamine echocardiography. 144 Previous data in 208 patients (including 61 women) suggested greater accuracy of high-dose dobutamine CMR as compared with high-dose dobutamine echocardiography with quantitative coronary angiography as the reference standard, 145 which supports its use as a measure of inducible myocardial ischemia.…”

Section: Diagnosismentioning

confidence: 99%

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease

Mieres¹,

Shaw²,

Arai³

et al. 2005

Circulation

408

166

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Abstract-Cardiovascular disease is the leading cause of mortality for women in the United States. Coronary heart disease, which includes coronary atherosclerotic disease, myocardial infarction, acute coronary syndromes, and angina, is the largest subset of this mortality, with Ͼ240 000 women dying annually from the disease. Atherosclerotic coronary artery disease (CAD) is the focus of this consensus statement. Research continues to report underrecognition and underdiagnosis of CAD as contributory to high mortality rates in women. Timely and accurate diagnosis can significantly reduce CAD mortality for women; indeed, once the diagnosis is made, it does appear that current treatments are equally effective at reducing risk in both women and men. As such, noninvasive diagnostic and prognostic testing offers the potential to identify women at increased CAD risk as the basis for instituting preventive and therapeutic interventions. Nevertheless, the recent evidence-based practice program report from the Agency for Healthcare Research and Quality noted the paucity of women enrolled in diagnostic research studies. Consequently, much of the evidence supporting contemporary recommendations for noninvasive diagnostic studies in women is extrapolated from studies conducted predominantly in cohorts of middle-aged men. The majority of diagnostic and prognostic evidence in cardiac imaging in women and men has been derived from observational registries and referral populations that are affected by selection and other biases. Thus, a better understanding of the potential impact of sex differences on noninvasive cardiac testing in women may greatly improve clinical decision making. This consensus statement provides a synopsis of available evidence on the role of the exercise ECG and cardiac imaging modalities, both those in common use as well as developing technologies that may add clinical value to the diagnosis and risk assessment of the symptomatic and asymptomatic woman with suspected CAD. (Circulation. 2005;111:682-696.)Key Words: AHA Scientific Statements Ⅲ women Ⅲ coronary disease Ⅲ imaging Ⅲ exercise testing C ardiovascular disease is the leading cause of mortality for women in the United States. Coronary heart disease, which includes coronary atherosclerotic disease, myocardial infarction (MI), acute coronary syndromes, and angina, is the largest subset of this mortality. Atherosclerotic coronary artery disease (CAD) is the focus of this consensus document. Although US men have experienced a decline in CAD deaths, the number of coronary deaths in women, Ͼ240 000 annually, has remained stable or has increased, depending on the study referenced. 1,2 CAD, which increases with advancing age, also is a substantial cause of morbidity and disability for US women. 3 Women, in particular young women (Ͻ55 years), have a worse prognosis from acute MI than their male counterparts, with a greater recurrence of MI and higherThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that ma...

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Section: Diagnosismentioning

confidence: 99%

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease

Mieres¹,

Shaw²,

Arai³

et al. 2005

Circulation

408

166

View full text Add to dashboard Cite

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“…Few studies have assessed the utility of CMR stress testing specifically in women [15,25-27]. The prior reports vary in imaging technology (older pulse sequences and different coil technology) [25], pre-test probability (patients with known CAD and prior MI included) [26], and CAD prevalence (low-risk ED patients with chest pain) [27]. The sensitivities and specificities in the previous studies ranged from 57%-95% and 75%-100%, which concurs with our results.…”

Section: Discussionmentioning

confidence: 99%

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Greulich

Bruder

Parker

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundExercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed.Methods and resultsWe prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA.Exercise ECG, CMR and CA was completed in 68 females (age 66.4 ± 8.8 years, number of CAD risk factors 3.5 ± 1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was −3.0 ± 5.4 and was similar in those with and without CAD (−4.5 ± 5.8 and −2.4 ± 5.1; P = 0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P = 0.02, specificities 94% and 73%, P = 0.01, and accuracies 91% and 66%, P = 0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94 ± 0.03 vs 0.56 ± 0.07; P = 0.0001).ConclusionsIn women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.

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“…Regions of myocardial perfusion deficit were determined by a consensus of experience MRI readers who then provided the qualitative reading, MRI QL . A semi-quantitative reading (MRI SQ ) of the MPI defect was performed using the product of the normalized uptake slope and signal gain from baseline to peak (5). Additionally, the myocardial flow reserve (MFR) was calculated as the ratio of the normalized stress to rest uptake slope.…”

Section: Cardiovascular Magnetic Resonancementioning

confidence: 99%

“…Multiple factors such as MFR and processing noise are known to affect the reproducibility, diagnostic and prognostic accuracy of MPI assessed by MRI (5,(11)(12)(13). Further, assessing MPI success using the degree of agreement with the cath lab-determined coronary artery stenosis level is not straight forward due to MRI's sensitivity to microvascular disease, collateral circulation and myocardial flow reserve (14).…”

Section: Diagnostic Versus Prognosticmentioning

confidence: 99%

Use of bio-informatics assessment schema (BIAS) to improve diagnosis and prognosis of myocardial perfusion data: results from the NHLBI-sponsored women’s ischemia syndrome evaluation (WISE)

Doyle

Pohost

Merz

et al. 2016

Cardiovasc. Diagn. Ther.

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Background:We introduce an algorithmic approach to optimize diagnostic and prognostic value of gated cardiac single photon emission computed tomography (SPECT) and magnetic resonance (MR) myocardial perfusion imaging (MPI) modalities in women with suspected myocardial ischemia. The novel approach: bioinformatics assessment schema (BIAS) forms a mathematical model utilizing MPI data and cardiac metrics generated by one modality to predict the MPI status of another modality. The model identifies cardiac features that either enhance or mask the image-based evidence of ischemia. For each patient, the BIAS model value is used to set an appropriate threshold for the detection of ischemia.Methods: Women (n=130), with symptoms and signs of suspected myocardial ischemia, underwent MPI assessment for regional perfusion defects using two different modalities: gated SPECT and MR. To determine perfusion status, MR data were evaluated qualitatively (MRI QL ) and semi-quantitatively (MRI SQ ) while SPECT data were evaluated using conventional clinical criteria. Evaluators were masked to results of the alternate modality. These MPI status readings were designated "original". Two regression models designated "BIAS" models were generated to model MPI status obtained with one modality (e.g., MRI) compared with a second modality (e.g., SPECT), but importantly, the BIAS models did not include the primary Original MPI reading of the predicting modality. Instead, the BIAS models included auxiliary measurements like left ventricular chamber volumes and myocardial wall thickness. For each modality, the BIAS model was used to set a progressive threshold for interpretation of MPI status. Women were then followed for 38±14 months for the development of a first major adverse cardiovascular event [MACE:CV death, nonfatal myocardial infarction (MI) or hospitalization for heart failure]. Original and BIASaugmented perfusion status were compared in their ability to detect coronary artery disease (CAD) and for prediction of MACE.Results: Adverse events occurred in 14 (11%) women and CAD was present in 13 (10%). There was a positive correlation of maximum coronary artery stenosis and BIAS score for MRI and SPECT (P<0.001).Receiver operator characteristic (ROC) analysis was conducted and showed an increase in the area IntroductionPreviously we showed that the initial (i.e., "original") interpretation of myocardial perfusion imaging (MPI) was improved by modeling the results of one modality, such as magnetic resonance imaging (MRI), against the results of another modality, such as single photon emission computed tomography (SPECT) for diagnosis and prognosis in women with signs and symptoms of ischemia (1). This approach, termed Decisions Informed by Combining Entities (DICE) better identified women likely to experience a major adverse cardiovascular event (MACE) versus the original reading. However, since the DICE formula incorporated the Original MPI reading it was constrained to convert false negatives to true positives, but did not convert fal...

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The Impact of Myocardial Flow Reserve on the Detection of Coronary Artery Disease by Perfusion Imaging Methods: An NHLBI WISE Study

Cited by 76 publications

References 34 publications

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

Use of bio-informatics assessment schema (BIAS) to improve diagnosis and prognosis of myocardial perfusion data: results from the NHLBI-sponsored women’s ischemia syndrome evaluation (WISE)

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