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Relevance of small areas of myocardial ischemia in adenosine stress MR

Background

We sought to compare the clinical relevance of reporting all the areas of ischemia observed at visual interpretation of stress perfusion ("radiologic" approach: method 1), versus the hypothesis of reporting only mild-to-moderate areas of ischemia, about 8 to 10% or more of LV mass ("cardiologic" approach: method 2).

Methods

Retrospective re-analysis of a series of 283 stress MR, with perfusion series acquired at 4' of adenosine infusion at 140 mcg/Kg/min, 3 slices every heart beat, allowing a 16-segments myocardial segmentation. MR adenosine stress was reported as positive: in method 1 in presence of any area of subendocardial perfusion defect, and in method 2 only if at least 3 subendocardial regions (3 half segments in the 16 segments model).

Results

We found 75 patients with a coronary angiography < 2 months after the diagnostic test. Patients with a negative stressMR were excluded in the absence of a coronary angiography. Prevalence of disease among the studied population was 73,3%. Method 1: sensitivity 89,1%, specificity 45%, PPV 81,6% (95%CI:70 to 89); NPV 60% (95% CI 35.7 to 80,2), global accuracy of 77,33%. Method 2: sensitivity78,2%, specificity 75%, PPV 89,6% (95% CI 77,8 to 95,5), NPV (95% CI 37,3 to 72,4), global accuracy of 73.3%.

Conclusions

Exclusion of small areas of ischemia doubled the number of false negative results from 6 to 12. The global accuracy of the exam did not change between the 2 reporting methods. Therefore, also small areas of myocardial ischemia should be reported in a stress MR report.

Funding

None.

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Correspondence to Lorenzo Monti.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Monti, L., Longaretti, F., Pia Del corral, M. et al. Relevance of small areas of myocardial ischemia in adenosine stress MR. J Cardiovasc Magn Reson 16, P197 (2014). https://doi.org/10.1186/1532-429X-16-S1-P197

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Keywords

  • Ischemia
  • Myocardial Ischemia
  • Coronary Angiography
  • Perfusion Defect
  • Segment Model