Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging
Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging
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DOI：
10.1016/j.jacc.2005.10.074
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发表时间：
2006-04-18
影响因子：
24
通讯作者：
Kim, RJ
中科院分区：
文献类型：
--
作者：
Klem, I;Heitner, JF;Kim, RJ
目的 我们测试了一种预定义的视觉判读算法，该算法结合了来自灌注和梗塞成像的心血管磁共振 (CMR) 数据来诊断冠状动脉疾病 (CAD)。 背景 心血管磁共振可以在单次会议中使用独立技术评估心肌灌注和梗塞。 方法 我们前瞻性地连续招募了 100 名疑似 CAD 的患者 用于X射线冠状动脉造影。对患者进行全面的临床评估，包括Rose心绞痛问卷、12导联心电图、C反应蛋白以及Framing-ham风险计算。心血管磁共振包括电影、腺苷应激和静息灌注 CMR 以及用于梗塞成像的延迟增强 CMR (DE-CMR)。 DE-CMR 在没有梗塞的情况下匹配的应激-休息灌注缺陷被认为是人为的。所有患者均在 CMR 后 24 小时内接受 X 射线血管造影。结果 92 名患者进行了完整的 CMR 检查。 37 名患者 (40%) 发现显着 CAD（≥ 70% 狭窄）。灌注和 DE-CMR 联合诊断 CAD 的敏感性、特异性和准确性分别为 89%、87% 和 88%，而单独灌注-CMR 的敏感性、特异性和准确性分别为 84%、58% 和 68%。由于结合了 DE-CMR 的极高特异性 (98%)，该组合具有更高的特异性和准确性 (p < 0.0001)。接受者操作特征曲线分析表明，该组合提供了比单独使用电影、灌注或 DE-CMR 更好的性能。单血管和多血管疾病的准确性很高，并且与 CAD 定位无关。包括标准临床参数在内的多变量分析表明，该组合是最强的独立 CAD 预测因子。 结论 结合灌注和梗塞 CMR 检查以及视觉判读算法可以在临床环境中准确诊断 CAD。该组合优于单独的灌注 CMR。
OBJECTIVES We tested a pre-defined visual interpretation algorithm that combines cardiovascular magnetic resonance (CMR) data from perfusion and infarction imaging for the diagnosis of coronary artery disease (CAD).BACKGROUND Cardiovascular magnetic resonance can assess both myocardial perfusion and infarction with independent techniques in a single session.METHODS We prospectively enrolled 100 consecutive patients with suspected CAD scheduled for X-ray coronary angiography. Patients had comprehensive clinical evaluation, including Rose angina questionnaire, 12-lead electrocardiography, C-reactive protein, and calculation of Framing-ham risk. Cardiovascular magnetic resonance included cine, adenosine-stress and rest perfusion-CMR, and delayed enhancement-CMR (DE-CMR) for infarction imaging. Matched stress-rest perfusion defects in the absence of infarction by DE-CMR were considered artifactual. All patients underwent X-ray angiography within 24 h of CMR.RESULTS Ninety-two patients had complete CMR examinations. Significant CAD (>= 70% stenosis) was found in 37 patients (40%). The combination of perfusion and DE-CMR had a sensitivity, specificity and accuracy of 89%, 87%, and 88%, respectively, for CAD diagnosis, compared with 84%, 58%, and 68%, respectively, for perfusion-CMR alone. The combination had higher specificity and accuracy (p < 0.0001), owing to incorporating the exceptionally high specificity (98%) of DE-CMR. Receiver operating characteristic curve analysis demonstrated the combination provided better performance than cine, perfusion, or DE-CMR alone. The accuracy was high in single-vessel and multivessel disease and independent of CAD location. Multivariable analysis including standard clinical parameters demonstrated the combination was the strongest independent CAD predictor.CONCLUSIONS A combined perfusion and infarction CMR examination with a visual interpretation algorithm can accurately diagnose CAD in the clinical setting. The combination is superior to perfusion-CMR alone.