Abstract
AimsThe aim of the study was to assess the feasibility and accuracy of an integrated stress imaging algorithm with echo first and second-line Cardiac Magnetic Resonance (CMR) in selected cases. Stress echo (SE) is widely used for non-invasive diagnosis of coronary artery disease (CAD), but difficult patients and ambiguous responses may be met even with top-level technology and expertise. CMR might ideally complement SE in well-selected cases with unfeasible and/or ambiguous and/or submaximal results.Methods and results152 in-hospital patients with chest pain and normal baseline function were referred for SE and coronary angiography. Of the initial population, 33 were shunted to CMR due to poor acoustic window or ambiguous or submaximal SE test. The only criterion of positivity for both techniques was the presence of regional wall motion abnormalities in at least 2 contiguous segments. Coronary angiography was performed independently of test results. Significant CAD was identified by a >50% quantitatively assessed diameter reduction in at least 1 major coronary vessel.CAD was present in 88 patients. Interpretable and diagnostic stress test were obtained in 143 patients with the sequential algorithm. The sequential (SE in 110 + CMR in 33 patients) algorithm showed a sensitivity of 76% (95% CI 66% to 85%) specificity of 87% (95% CI 76% to 95%) and accuracy of 80% (95% CI 73% to 86%).ConclusionA sequential functional stress imaging algorithm with stress echo first and stress CMR in selected cases is feasible, clinically realistic and allows an efficient, radiation-free diagnosis of CAD.
Highlights
Stress echocardiography is an established cost-effective technique for the detection of coronary artery disease [1]
Patients Starting January 2003, from the data bank of the Institute of Clinical Physiology, 143 (101 males; 64 ± 9 years) nonconsecutive in-hospital patients or outpatients referred to the stress echocardiography laboratory for evaluation of chest pain, or patients with known coronary artery disease, or both were enrolled in the study
Four patients who experienced side effects during dipyridamole stress echocardiography were referred to dobutamine stress echocardiography
Summary
Stress echocardiography is an established cost-effective technique for the detection of coronary artery disease [1]. According to the guidelines of European Society of Cardiology and American Society of Echocardiography – stress echocardiography (with exercise, dobutamine or dipyridamole) is a class I indication (of documented effectiveness and usefulness) for the diagnosis of coronary artery disease and for the prognostic stratification of patients with known coronary artery disease [2,3]. The advantages of the technique are related to its less pronounced operator-independence and the absence of ionising radiation, at the price of higher costs and lower availability when compared with echocardiography. The aim of the study was to assess the feasibility and accuracy of an integrated algorithm with stress echo first and second-line stress CMR in selected cases
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