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Stress cardiac MR imaging compared with stress echocardiography in the early evaluation of patients who present to the emergency department with intermediate-risk chest pain.

Publication ,  Journal Article
Heitner, JF; Klem, I; Rasheed, D; Chandra, A; Kim, HW; Van Assche, LMR; Parker, M; Judd, RM; Jollis, JG; Kim, RJ
Published in: Radiology
April 2014

PURPOSE: To compare the utility and efficacy of stress cardiac magnetic resonance (MR) imaging and stress echocardiography in an emergency setting in patients with acute chest pain (CP) and intermediate risk of coronary artery disease (CAD). MATERIALS AND METHODS: Written informed consent was obtained from all patients. This HIPAA-compliant study was approved by the institutional review board for research ethics. Sixty patients without history of CAD presented to the emergency department with intermediate-risk acute CP and were prospectively enrolled. Patients underwent both stress cardiac MR imaging and stress echocardiography in random order within 12 hours of presentation. Stress imaging results were interpreted clinically immediately (blinded interpretation was performed months later), and coronary angiography was performed if either result was abnormal. CAD was considered significant if it was identified at angiography (narrowing >50% ) or if a cardiac event (death or myocardial infarction) occurred during follow-up (mean, 14 months ± 5 [standard deviation]). McNemar test was used to compare the diagnostic accuracy of techniques. RESULTS: Stress cardiac MR imaging and stress echocardiography had similar specificity, accuracy, and positive and negative predictive values (92% vs 96%, 93% vs 88%, 67% vs 60%, and 100% vs 91%, respectively, for clinical interpretation; 90% vs 92%, 90% vs 88%, 58% vs 56%, and 98% vs 94%, respectively, for blinded interpretation). Stress cardiac MR imaging had higher sensitivity at clinical interpretation (100% vs 38%, P = .025), which did not reach significance at blinded interpretation (88% vs 63%, P = .31). However, multivariable logistic regression analysis showed stress cardiac MR imaging to be the strongest independent predictor of significant CAD (P = .002). CONCLUSION: In patients presenting to the emergency department with intermediate-risk CP, adenosine stress cardiac MR imaging performed within 12 hours of presentation is safe and potentially has improved performance characteristics compared with stress echocardiography. Online supplemental material is available for this article.

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Published In

Radiology

DOI

EISSN

1527-1315

Publication Date

April 2014

Volume

271

Issue

1

Start / End Page

56 / 64

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Risk Factors
  • Risk Assessment
  • Predictive Value of Tests
  • Organometallic Compounds
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Heitner, J. F., Klem, I., Rasheed, D., Chandra, A., Kim, H. W., Van Assche, L. M. R., … Kim, R. J. (2014). Stress cardiac MR imaging compared with stress echocardiography in the early evaluation of patients who present to the emergency department with intermediate-risk chest pain. Radiology, 271(1), 56–64. https://doi.org/10.1148/radiol.13130557
Heitner, John F., Igor Klem, Derek Rasheed, Abhinav Chandra, Han W. Kim, Lowie M. R. Van Assche, Michele Parker, Robert M. Judd, James G. Jollis, and Raymond J. Kim. “Stress cardiac MR imaging compared with stress echocardiography in the early evaluation of patients who present to the emergency department with intermediate-risk chest pain.Radiology 271, no. 1 (April 2014): 56–64. https://doi.org/10.1148/radiol.13130557.
Heitner, John F., et al. “Stress cardiac MR imaging compared with stress echocardiography in the early evaluation of patients who present to the emergency department with intermediate-risk chest pain.Radiology, vol. 271, no. 1, Apr. 2014, pp. 56–64. Pubmed, doi:10.1148/radiol.13130557.
Heitner JF, Klem I, Rasheed D, Chandra A, Kim HW, Van Assche LMR, Parker M, Judd RM, Jollis JG, Kim RJ. Stress cardiac MR imaging compared with stress echocardiography in the early evaluation of patients who present to the emergency department with intermediate-risk chest pain. Radiology. 2014 Apr;271(1):56–64.

Published In

Radiology

DOI

EISSN

1527-1315

Publication Date

April 2014

Volume

271

Issue

1

Start / End Page

56 / 64

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Risk Factors
  • Risk Assessment
  • Predictive Value of Tests
  • Organometallic Compounds
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans