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[Ischemic heart disease : More than just chronic CAD]
Sebastian Reinartz1, Katharina Fischbach2
1Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland. Sebastian.Reinartz@med.uni-duesseldorf.de.
Insights
Adenosine-regadenoson stress MRI effectively diagnoses myocardial ischemia and obstructive coronary artery disease (CAD), offering superior accuracy to SPECT. This non-invasive imaging is crucial for assessing cardiac event risk.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Context:
- Myocardial ischemia, a deficiency in oxygen supply to cardiomyocytes, necessitates effective diagnostic tools for primary and secondary prophylaxis of myocardial infarction.
- Non-invasive stress testing is vital for evaluating patients with suspected or intermediate-risk coronary artery disease (CAD).
Purpose:
- To evaluate the diagnostic accuracy of Adenosine-regadenoson stress magnetic resonance imaging (AR-stress MRI) for detecting obstructive CAD.
- To compare the performance of AR-stress MRI against other imaging modalities like SPECT.
Summary:
- AR-stress MRI demonstrates high pooled sensitivity (87.7%) and specificity (88.6%) for diagnosing obstructive CAD, outperforming SPECT (AUC 0.89 vs. 0.74).
- The technique is effective for assessing myocardial ischemia and viability (using late gadolinium enhancement), which are key prognostic factors for major adverse cardiac events.
- Clinical guidelines increasingly recommend stress MRI for patients with intermediate CAD risk and stable symptoms.
Impact:
- AR-stress MRI provides a robust, non-invasive method for diagnosing myocardial ischemia and obstructive CAD, aiding in risk stratification and treatment decisions.
- The findings support the integration of AR-stress MRI into clinical practice for improved patient outcomes in cardiovascular disease management.
Clinical/Methodological Issue:
Myocardial ischemia as a reduction in perfusion with therefore oxygen deficiency of vital cardiomyocytes. Thus primary and secondary prophylaxis of myocardial infarction and it's complications.
Standard Radiological Methods:
Adenosine-regadenoson stress magnetic resonance imaging (AR-stress MRI), computed tomography coronary angiography (CTCA).
Methodological Innovations:
Non-invasive stress testing using AR-stress MRI to exclude relevant obstructive coronary artery disease (CAD).
Performance:
Meta-analysis: The diagnosis of obstructive CAD at the coronary artery level has a pooled sensitivity of 87.7% and a specificity of 88.6%. Diagnostic accuracy is better than single photon emission computed tomography (SPECT; AUC 0.89 vs. 0.74).
Achievements:
AR-stress MRI can be used to assess myocardial ischemia in the setting of obstructive CAD. Current clinical guidelines for myocardial revascularization have strengthened the use of stress MRI in patients with intermediate risk of CAD and stable symptoms. Cardiac MR imaging using late gadolinium enhancement (LGE) is considered gold standard for myocardial viability assessment in vivo. Both viability and ischemia are considered prognostic factors for major adverse cardiac events.
Practical Recommendations:
AR-stress MRI is used to diagnose myocardial ischemia in combination with viability imaging (LGE). Dobutamine-atropine (DoA) stress MRI is an alternative in the setting of contraindications for AR or specific clinical questions.
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