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Safety and diagnostic accuracy of stress cardiac magnetic resonance imaging vs exercise tolerance testing early after acute ST elevation myocardial infarction

¹ Academic Unit of Cardiovascular Medicine and Cardiac Magnetic Resonance Unit, Leeds General Infirmary, University of Leeds, Leeds, UK
² Cardiac Magnetic Resonance Unit, Leeds General Infirmary, Leeds, UK
³ Department of Medical Physics, Leeds General Infirmary, Leeds, UK

Correspondence to:
Dr J P Greenwood, Academic Unit of Cardiovascular Medicine, G-floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK; j.greenwood{at}leeds.ac.uk

ABSTRACT
Objective: To determine the safety and diagnostic accuracy of adenosine-stress cardiac magnetic resonance (CMR) perfusion imaging early after acute ST elevation myocardial infarction (STEMI) compared with standard exercise tolerance testing (ETT).

Design and setting: Cross sectional observational study in a university teaching hospital.

Patients: 35 patients admitted with first acute STEMI.

Interventions: All patients underwent a CMR imaging protocol which included rest and adenosine-stress perfusion, viability, and cardiac functional assessment. All patients also had an ETT (modified Bruce protocol) and x ray coronary angiography.

Main outcome measures: Safety and diagnostic accuracy of adenosine-stress perfusion CMR vs ETT early after STEMI in identifying patients with significant coronary stenosis (70%) and the need for coronary revascularisation. Also, to determine if CMR can distinguish between ischaemia in the peri-infarct zone and ischaemia in remote myocardium.

Results: CMR imaging was well tolerated (all patients completed the protocol) and no complications occurred. CMR was more sensitive (86% vs 48%, p = 0.0074) and more specific than ETT (100% vs 50%, p<0.0001) for detecting significant coronary stenosis, and more sensitive for predicting revascularisation (94% vs 56%, p = 0.039). Inducible ischaemia in the infarct related artery territory was seen in 21 of 35 patients and was associated with smaller infarct size and less transmurality of infarction.

Conclusions: Adenosine-stress CMR imaging is safe early after acute STEMI and identifies patients with significant coronary stenosis more accurately than ETT.

Abbreviations: CMR, cardiac magnetic resonance; ETT, exercise tolerance test; IRA, infarct related artery; STEMI, ST elevation myocardial infarction; TIMI, Thrombolysis in Myocardial Infarction trial

Keywords: magnetic resonance imaging; myocardial infarction; coronary heart disease; myocardial perfusion; myocardial ischaemia