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Influence of small caliber coronary arteries on the diagnostic accuracy of adenosine stress cardiac magnetic resonance imaging.

Pilz G, Heer T, Graw M, Ali E, Klos M, Scheck R, Zeymer U, Höfling B - Clin Res Cardiol (2010)

Bottom Line: After adenosine infusion, myocardial first-pass sequence using gadolinium-based contrast agent was performed and compared with rest perfusion.We found a significant association between FP CMR and the presence of a small caliber coronary vessel (proximal diameter < one standard deviation below the mean) supplying the area of ischemia (chi-square 42.6, p < 0.0001).Small caliber coronary arteries found as normal variations in right-dominant or left-dominant circulation may account for hypoperfusion in the absence of coronary stenosis and thus may cause FP adenosine stress CMR results.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Clinic Agatharied, Academic Teaching Hospital, University of Munich, Norbert-Kerkel-Platz, Hausham, Germany. pilz@khagatharied.de

ABSTRACT

Background and aims: Positive predictive value (PPV) of adenosine stress cardiac magnetic resonance (CMR) for coronary artery disease (CAD) is unsatisfactory. We investigated the impact of coronary caliber variability on this limitation in CMR performance.

Methods and results: 206 consecutive patients with myocardial ischemia during CMR and subsequent coronary angiography (CA) were studied. Patients were examined in a 1.5-T scanner. After adenosine infusion, myocardial first-pass sequence using gadolinium-based contrast agent was performed and compared with rest perfusion. CAD was invasively confirmed in 165 [true positive (TP); PPV, 80.1%] and ruled out in 41 patients [false positive (FP)]. TP and FP were comparable for pre-test risk and CMR findings. We found a significant association between FP CMR and the presence of a small caliber coronary vessel (proximal diameter < one standard deviation below the mean) supplying the area of ischemia (chi-square 42.6, p < 0.0001). A small caliber artery ipsilateral to the ischemic region was a predictive parameter for FP versus TP discrimination (ROC area, 0.84 ± 0.04 vs. 0.59 ± 0.05; p < 0.0001). Further increment in diagnostic accuracy was achieved by including proximal ipsilateral/contralateral coronary diameter ratios (ROC area, 0.90 ± 0.03; p < 0.03).

Conclusions: Small caliber coronary arteries found as normal variations in right-dominant or left-dominant circulation may account for hypoperfusion in the absence of coronary stenosis and thus may cause FP adenosine stress CMR results. Non-invasive assessment of proximal coronary diameters in the vessel supplying the area of ischemia could reduce FP rates, raise the diagnostic accuracy of CMR for CAD and minimize subsequent superfluous CA.

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Related in: MedlinePlus

Coronary artery diameters. Proximal diameters of the coronary vessels according to the type of coronary dominance (a) and to the validity (TP or FP) of CMR perfusion results (b)
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Fig1: Coronary artery diameters. Proximal diameters of the coronary vessels according to the type of coronary dominance (a) and to the validity (TP or FP) of CMR perfusion results (b)

Mentions: Coronary angiography confirmed that the proximal diameters of the coronary vessels correlated well with the type of coronary dominance (Fig. 1a). In balanced circulation, the proximal diameters of RCA, LCX and LAD were comparable. In right-dominant circulation, proximal RCA was significantly larger compared to LCX and LAD. In the cases of a left-dominant coronary tree, proximal RCA diameter was significantly smaller than the opposite larger proximal diameters of LCX and LAD.Fig. 1


Influence of small caliber coronary arteries on the diagnostic accuracy of adenosine stress cardiac magnetic resonance imaging.

Pilz G, Heer T, Graw M, Ali E, Klos M, Scheck R, Zeymer U, Höfling B - Clin Res Cardiol (2010)

Coronary artery diameters. Proximal diameters of the coronary vessels according to the type of coronary dominance (a) and to the validity (TP or FP) of CMR perfusion results (b)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3040827&req=5

Fig1: Coronary artery diameters. Proximal diameters of the coronary vessels according to the type of coronary dominance (a) and to the validity (TP or FP) of CMR perfusion results (b)
Mentions: Coronary angiography confirmed that the proximal diameters of the coronary vessels correlated well with the type of coronary dominance (Fig. 1a). In balanced circulation, the proximal diameters of RCA, LCX and LAD were comparable. In right-dominant circulation, proximal RCA was significantly larger compared to LCX and LAD. In the cases of a left-dominant coronary tree, proximal RCA diameter was significantly smaller than the opposite larger proximal diameters of LCX and LAD.Fig. 1

Bottom Line: After adenosine infusion, myocardial first-pass sequence using gadolinium-based contrast agent was performed and compared with rest perfusion.We found a significant association between FP CMR and the presence of a small caliber coronary vessel (proximal diameter < one standard deviation below the mean) supplying the area of ischemia (chi-square 42.6, p < 0.0001).Small caliber coronary arteries found as normal variations in right-dominant or left-dominant circulation may account for hypoperfusion in the absence of coronary stenosis and thus may cause FP adenosine stress CMR results.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Clinic Agatharied, Academic Teaching Hospital, University of Munich, Norbert-Kerkel-Platz, Hausham, Germany. pilz@khagatharied.de

ABSTRACT

Background and aims: Positive predictive value (PPV) of adenosine stress cardiac magnetic resonance (CMR) for coronary artery disease (CAD) is unsatisfactory. We investigated the impact of coronary caliber variability on this limitation in CMR performance.

Methods and results: 206 consecutive patients with myocardial ischemia during CMR and subsequent coronary angiography (CA) were studied. Patients were examined in a 1.5-T scanner. After adenosine infusion, myocardial first-pass sequence using gadolinium-based contrast agent was performed and compared with rest perfusion. CAD was invasively confirmed in 165 [true positive (TP); PPV, 80.1%] and ruled out in 41 patients [false positive (FP)]. TP and FP were comparable for pre-test risk and CMR findings. We found a significant association between FP CMR and the presence of a small caliber coronary vessel (proximal diameter < one standard deviation below the mean) supplying the area of ischemia (chi-square 42.6, p < 0.0001). A small caliber artery ipsilateral to the ischemic region was a predictive parameter for FP versus TP discrimination (ROC area, 0.84 ± 0.04 vs. 0.59 ± 0.05; p < 0.0001). Further increment in diagnostic accuracy was achieved by including proximal ipsilateral/contralateral coronary diameter ratios (ROC area, 0.90 ± 0.03; p < 0.03).

Conclusions: Small caliber coronary arteries found as normal variations in right-dominant or left-dominant circulation may account for hypoperfusion in the absence of coronary stenosis and thus may cause FP adenosine stress CMR results. Non-invasive assessment of proximal coronary diameters in the vessel supplying the area of ischemia could reduce FP rates, raise the diagnostic accuracy of CMR for CAD and minimize subsequent superfluous CA.

Show MeSH
Related in: MedlinePlus