Cardiovascular magnetic resonance stress perfusion imaging predicts 1 year outcomes following equivocal stress testing

Abstract

Summary We tested the hypothesis that cardiovascular magnetic resonance (CMR) stress perfusion can predict 1 year outcomes in individuals with equivocal or uncertain prior stress testing. Background Individuals with equivocal nuclear stress test results are at higher risk for cardiac events compared to those with normal studies. CMR stress perfusion imaging identifies individuals with coronary artery disease with high sensitivity and specificity, with excellent spatial resolution, and without ionizing radiation. The utility of CMR stress testing is uncertain in individuals with prior equivocal stress results. Methods We selected all participants in a CMR registry who were clinically referred for pharmacologic CMR perfusion testing due to recent nuclear stress perfusion study (6 months if outpatient, same admission if inpatient) from 2009-2010 with equivocal or uncertain results. Studies were defined as equivocal if the results were qualified by the mention of significant artifact or other technical difficulty. Studies were defined as uncertain if the referring physician documented suspicion of false positive or false negative results in the medi cal record. The presence of ischemia reported by each modality, as well as any description of uncertainty, was determined by a clinical nurse reviewer and 2 cardiologists (all blinded to the downstream clinical course of each subject). Any disagreement in assessment was arbitrated by majority vote. The clinical course of each subject was followed through chart review. Adverse outcome was defined as hospitalization for suspected or definite myocardial infarction.