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

Jens Vogel-Claussen, Jan Skrok, David Dombroski, Steven M. Shea, Edward P. Shapiro, Mark Bohlman, Christine H. Lorenz, Joao A.C. Lima, David A. Bluemke

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)753-762
Number of pages10
JournalJournal of Magnetic Resonance Imaging
Volume30
Issue number4
DOIs
StatePublished - Oct 1 2009

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Keywords

  • Adenosine stress perfusion cardiac MRI
  • Chest pain
  • Emergency room
  • Microvascular disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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