Abstract 2808: Combination of Adenosine Stress Perfusion and Late Enhancement Cardiac Magnetic Resonance Imaging in Patients with Suspected Coronary Artery Disease, Percutaneous Coronary Intervention and Coronary Bypass Graft -A Multi-Center Study

Abstract

The combination of stress perfusion and late Gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR) has been established for diagnosis of myocardial ischemia. However, little is known about this helpful clinical examination tool in patients who were treated by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Aim of our study was to compare the diagnostic accuracy of stress perfusion and LGE in patients with suspected coronary artery disease (CAD), with PCI and with CABG in a multi-center trial. 477 patients with suspected CAD, 209 with PCI and 110 with CABG were included to the study and underwent adenosine stress perfusion and LGE 10 min. after a second bolus of contrast agent. CMR images were assessed visually using the 16-segments model. Myocardial ischemia was defined as resgional hypoenhancement in stress perfusion with absent LGE. All patients underwent coronary angiography. A significant stenosis was defined by QCA in case of ≥70% of coronary artery or bypass graft narrowing in vessels ≥2 mm diameter. A relevant vessel stenosis or occlusion was present in 173 (36%) patients with susptectd CAD, 69 (29%) PCI and 71 (65%) CABG patients. PCI was performed 314±231 and CABG 423±275 days before CMR examination. Sensitivity, specificity and overall accuracy per patient are given in table 1 CMR is feasible and suitable for detecting relevant vessel stenosis in patients who previously were treated by PCI or CABG. Diagnostic accuracy is reduced in patients with CABG. This could be due to different flow and perfusion kinetic. Furthermore, presented evaluation method may be inadequate, since collaterals and different perfusion territories are not taken into consideration. CMR yields similar diagnostic accuracy in patients with suspected CAD and those who previously were treated by PCI.