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Adenosine magnetic resonance imaging versus dobutamine stress echocardiography in patients with low probability for coronary artery disease

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Journal of Cardiovascular Magnetic Resonance200911 (Suppl 1) :O36

https://doi.org/10.1186/1532-429X-11-S1-O36

  • Published:

Keywords

  • Coronary Artery Disease
  • Ischemia
  • Aspirin
  • Baseline Characteristic
  • Chest Pain

Introduction

Accurate assessment of patients with chest pain without electrocardiographic changes or elevation of serum cardiac enzymes is challenging. There is increased interest in the role of dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI) performed in the chest pain unit as a diagnostic method to rule out Coronary Artery Disease (CAD) as the cause of the chest pain in this population.

Purpose

The purpose of this study was to compare DSE and AMRI in patients with low probability of CAD.

Methods

Inclusion criteria for the study were patients with normal EKG (no signs of cardiac ischemia) and negative cardiac enzymes, who were admitted to the Cardiac Decision Unit (CDU) from 2006–2008 at Emory University Hospital. The diagnostic method used was chosen randomly by physician preference. T-test was used to assess differences in continuous variables, and X2 square to test differences in categorical variables between the two groups. Logistic regression was used to assess the likelihood of detecting CAD after adjusting for technique used and baseline characteristics.

Results

A total of 306 patients were included, 103 patients were evaluated with AMRI and 203 underwent DSE. Mean age was similar among groups (52 for AMRI vs. 54 for DSE). Patients in AMRI group were more likely to be males, had more risk factors for CAD, and used more Beta blockers or aspirin at baseline compared to patients evaluated by DSE. AMRI identified more patients as having CAD compared to DSE (13 (12.6%) vs.3 (1.5%), p = < 0.0001). This difference remained significant even after adjusting for baseline characteristics and risk factors [OR of CAD by AMRI vs DSE = 7.01, CI (1.48–33.16) p = 0.014]. (Data in Table 1.)

Table 1

Characteristics

MRI

DSE

p-value

AGE

52 ± 12

54 ± 13

0.0571

Gender (males)

144 (70.9%)

38 (38%)

<0.0001

CAD

16 (16%)

13 (6.4%)

0.0076

HTN

66 (64.7%)

111 (54.7%)

0.0941

DM

30 (29.7%)

36 (17.7%)

0.0171

SMOKING

20 (19.6%)

39 (19.5%)

0.2967

Dyslipidemia

40 (39.2%)

46 (22.8%)

0.0027

Family_history_of_CAD

52 (51%)

74 (54.4%)

0.6029

EF

65.0 ± 10.4

64.2 ± 6.1

0.4235

Coronoary Artery Disease

13 (12.6%)

3 (1.5%)

<0.0001

Beta Blocker use

29 (28.4%)

25 (12.4%)

0.0005

Ca_B

19 (18.6%)

27 (13.4%)

0.2268

ACEi

21 (20.6%)

21 (10.4%)

0.015

ARBs

14 (13.7%)

20 (9.9%)

0.3178

ASA

27 (26.5%)

21 (10.4%)

0.0003

Conclusion

In this prospective study of patients with low probability of CAD, AMRI identified more cases of CAD than DSE even after adjusting for baseline characteristics. Although selection bias could account for part of these results, a higher sensitivity for AMRI is suggested.

Authors’ Affiliations

(1)
Emory University, Atlanta, GA, USA

Copyright

© Lerakis et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.

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