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Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/69238

Type: Journal article
Title: Diagnostic accuracy of adenosine stress cardiovascular magnetic resonance following acute ST-segment elevation myocardial infarction post primary angioplasty
Author: Wong, T.
Leung, M.
Das, R.
Liew, G.
Williams, K.
Dundon, B.
Molaee, P.
Teo, K.
Meredith, I.
Worthley, M.
Worthley, S.
Citation: Journal of Cardiovascular Magnetic Resonance, 2011; 13(October):62:1-62:8
Publisher: Marcel Dekker Inc
Issue Date: 2011
ISSN: 1097-6647
1532-429X
Statement of
Responsibility: 
Dennis TL Wong, Michael CH Leung, Rajiv Das, Gary YH Liew, Kerry Williams, Benjamin K Dundon, Payman Molaee, Karen SL Teo, Ian T Meredith, Matthew I Worthley and Stephen G Worthley
Abstract: Background: Adenosine stress cardiovascular magnetic resonance (CMR) has been proven an effective tool in detection of reversible ischemia. Limited evidence is available regarding its accuracy in the setting of acute coronary syndromes, particularly in evaluating the significance of non-culprit vessel ischaemia. Adenosine stress CMR and recent advances in semi-quantitative image analysis may prove effective in this area. We sought to determine the diagnostic accuracy of semi-quantitative versus visual assessment of adenosine stress CMR in detecting ischemia in non-culprit territory vessels early after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: Patients were prospectively enrolled in a CMR imaging protocol with rest and adenosine stress perfusion, viability and cardiac functional assessment 3 days after successful primary-PCI for STEMI. Three short axis slices each divided into 6 segments on first pass adenosine perfusion were visually and semi-quantitatively analysed. Diagnostic accuracy of both methods was compared with non-culprit territory vessels utilising quantitative coronary angiography (QCA) with significant stenosis defined as ≥70%. Results: Fifty patients (age 59 ± 12 years) admitted with STEMI were evaluated. All subjects tolerated the adenosine stress CMR imaging protocol with no significant complications. The cohort consisted of 41% anterior and 59% non anterior infarctions. There were a total of 100 non-culprit territory vessels, identified on QCA. The diagnostic accuracy of semi-quantitative analysis was 96% with sensitivity of 99%, specificity of 67%, positive predictive value (PPV) of 97% and negative predictive value (NPV) of 86%. Visual analysis had a diagnostic accuracy of 93% with sensitivity of 96%, specificity of 50%, PPV of 97% and NPV of 43%. Conclusion: Adenosine stress CMR allows accurate detection of non-culprit territory stenosis in patients successfully treated with primary-PCI post STEMI. Semi-quantitative analysis may be required for improved accuracy. Larger studies are however required to demonstrate that early detection of non-culprit vessel ischemia in the post STEMI setting provides a meaningful test to guide clinical decision making and ultimately improved patient outcomes.
Keywords: Humans; Coronary Stenosis; Myocardial Infarction; Adenosine; Vasodilator Agents; Magnetic Resonance Imaging; Coronary Angiography; Treatment Outcome; Severity of Illness Index; Odds Ratio; Sensitivity and Specificity; Chi-Square Distribution; Prospective Studies; Predictive Value of Tests; Coronary Circulation; Time Factors; Aged; Middle Aged; South Australia; Female; Male; Myocardial Perfusion Imaging; Angioplasty, Balloon, Coronary
Description: Extent: 8p.
Rights: © 2011 Wong et al; licensee BioMed Central Ltd.
RMID: 0020115180
DOI: 10.1186/1532-429X-13-62
Appears in Collections:Medicine publications
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