Limits...
Cardiac functional stress imaging: a sequential approach with stress echo and cardiovascular magnetic resonance.

Sicari R, Pingitore A, Aquaro G, Pasanisi EG, Lombardi M, Picano E - Cardiovasc Ultrasound (2007)

Bottom Line: CMR might ideally complement SE in well-selected cases with unfeasible and/or ambiguous and/or submaximal results. 152 in-hospital patients with chest pain and normal baseline function were referred for SE and coronary angiography.Coronary angiography was performed independently of test results.The sequential (SE in 110 + CMR in 33 patients) algorithm showed a sensitivity of 76% (95% CI 66% to 85%) specificity of 87% (95% CI 76% to 95%) and accuracy of 80% (95% CI 73% to 86%).

View Article: PubMed Central - HTML - PubMed

Affiliation: CNR, Institute of Clinical Physiology, Pisa, Italy. rosas@ifc.cnr.it

ABSTRACT

Aims: The aim of the study was to assess the feasibility and accuracy of an integrated stress imaging algorithm with echo first and second-line Cardiac Magnetic Resonance (CMR) in selected cases. Stress echo (SE) is widely used for non-invasive diagnosis of coronary artery disease (CAD), but difficult patients and ambiguous responses may be met even with top-level technology and expertise. CMR might ideally complement SE in well-selected cases with unfeasible and/or ambiguous and/or submaximal results.

Methods and results: 152 in-hospital patients with chest pain and normal baseline function were referred for SE and coronary angiography. Of the initial population, 33 were shunted to CMR due to poor acoustic window or ambiguous or submaximal SE test. The only criterion of positivity for both techniques was the presence of regional wall motion abnormalities in at least 2 contiguous segments. Coronary angiography was performed independently of test results. Significant CAD was identified by a >50% quantitatively assessed diameter reduction in at least 1 major coronary vessel.CAD was present in 88 patients. Interpretable and diagnostic stress test were obtained in 143 patients with the sequential algorithm. The sequential (SE in 110 + CMR in 33 patients) algorithm showed a sensitivity of 76% (95% CI 66% to 85%) specificity of 87% (95% CI 76% to 95%) and accuracy of 80% (95% CI 73% to 86%).

Conclusion: A sequential functional stress imaging algorithm with stress echo first and stress CMR in selected cases is feasible, clinically realistic and allows an efficient, radiation-free diagnosis of CAD.

Show MeSH

Related in: MedlinePlus

Bar graph showing the number of maximal and/or interpretable tests for each technique employed (exercise stress echo, dipyridamole stress echo and dipyridamole CMR). The number of maximal tests increases when the sequential algorithm is applied.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2262078&req=5

Figure 2: Bar graph showing the number of maximal and/or interpretable tests for each technique employed (exercise stress echo, dipyridamole stress echo and dipyridamole CMR). The number of maximal tests increases when the sequential algorithm is applied.

Mentions: Significant coronary artery disease was present in 71 of the 110 who underwent stress echocardiography and in 17 of the 33 who underwent dipyridamole CMR. The number of interpretable and/or maximal tests and test sensitivity significantly increased, with only a negligible loss of specificity when the sequential model was applied (fig.2 and 3). In fact sensitivity for detecting CAD was 63% (95% CI 52% to 73%) for stress echo consecutive patients and increased to 76% (95% CI 66% to 84%) for the sequential model with stress CMR; specificity was 89% (95% CI 78% to 96%) and 87% for stress CMR (95% CI 75% to 94%), respectively. Accuracy was 73% for stress echo (95% CI 65% to 80%) and increased to 80% (95% CI 73% to 86%) when stress CMR was employed.


Cardiac functional stress imaging: a sequential approach with stress echo and cardiovascular magnetic resonance.

Sicari R, Pingitore A, Aquaro G, Pasanisi EG, Lombardi M, Picano E - Cardiovasc Ultrasound (2007)

Bar graph showing the number of maximal and/or interpretable tests for each technique employed (exercise stress echo, dipyridamole stress echo and dipyridamole CMR). The number of maximal tests increases when the sequential algorithm is applied.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2262078&req=5

Figure 2: Bar graph showing the number of maximal and/or interpretable tests for each technique employed (exercise stress echo, dipyridamole stress echo and dipyridamole CMR). The number of maximal tests increases when the sequential algorithm is applied.
Mentions: Significant coronary artery disease was present in 71 of the 110 who underwent stress echocardiography and in 17 of the 33 who underwent dipyridamole CMR. The number of interpretable and/or maximal tests and test sensitivity significantly increased, with only a negligible loss of specificity when the sequential model was applied (fig.2 and 3). In fact sensitivity for detecting CAD was 63% (95% CI 52% to 73%) for stress echo consecutive patients and increased to 76% (95% CI 66% to 84%) for the sequential model with stress CMR; specificity was 89% (95% CI 78% to 96%) and 87% for stress CMR (95% CI 75% to 94%), respectively. Accuracy was 73% for stress echo (95% CI 65% to 80%) and increased to 80% (95% CI 73% to 86%) when stress CMR was employed.

Bottom Line: CMR might ideally complement SE in well-selected cases with unfeasible and/or ambiguous and/or submaximal results. 152 in-hospital patients with chest pain and normal baseline function were referred for SE and coronary angiography.Coronary angiography was performed independently of test results.The sequential (SE in 110 + CMR in 33 patients) algorithm showed a sensitivity of 76% (95% CI 66% to 85%) specificity of 87% (95% CI 76% to 95%) and accuracy of 80% (95% CI 73% to 86%).

View Article: PubMed Central - HTML - PubMed

Affiliation: CNR, Institute of Clinical Physiology, Pisa, Italy. rosas@ifc.cnr.it

ABSTRACT

Aims: The aim of the study was to assess the feasibility and accuracy of an integrated stress imaging algorithm with echo first and second-line Cardiac Magnetic Resonance (CMR) in selected cases. Stress echo (SE) is widely used for non-invasive diagnosis of coronary artery disease (CAD), but difficult patients and ambiguous responses may be met even with top-level technology and expertise. CMR might ideally complement SE in well-selected cases with unfeasible and/or ambiguous and/or submaximal results.

Methods and results: 152 in-hospital patients with chest pain and normal baseline function were referred for SE and coronary angiography. Of the initial population, 33 were shunted to CMR due to poor acoustic window or ambiguous or submaximal SE test. The only criterion of positivity for both techniques was the presence of regional wall motion abnormalities in at least 2 contiguous segments. Coronary angiography was performed independently of test results. Significant CAD was identified by a >50% quantitatively assessed diameter reduction in at least 1 major coronary vessel.CAD was present in 88 patients. Interpretable and diagnostic stress test were obtained in 143 patients with the sequential algorithm. The sequential (SE in 110 + CMR in 33 patients) algorithm showed a sensitivity of 76% (95% CI 66% to 85%) specificity of 87% (95% CI 76% to 95%) and accuracy of 80% (95% CI 73% to 86%).

Conclusion: A sequential functional stress imaging algorithm with stress echo first and stress CMR in selected cases is feasible, clinically realistic and allows an efficient, radiation-free diagnosis of CAD.

Show MeSH
Related in: MedlinePlus