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Safety and diagnostic accuracy of stress Cardiac Magnetic Resonance imaging versus Exercise Tolerance Testing early after acute ST-Elevation Myocardial Infarction
  1. John P Greenwood (j.greenwood{at}leeds.ac.uk)
  1. Academic Unit of Cardiovascular Medicine, University of Leeds, United Kingdom
    1. John F Younger
    1. Academic Unit of Cardiovascular Medicine, University of Leeds, United Kingdom
      1. John P Ridgway
      1. Department of Medical Physics, Leeds General Infirmary, United Kingdom
        1. Mohan U Sivananthan
        1. Cardiac Magnetic Resonance Unit, Leeds General Infirmary, United Kingdom
          1. Stephen G Ball
          1. Academic Unit of Cardiovascular Medicine, University of Leeds, United Kingdom
            1. Sven Plein
            1. Academic Unit of Cardiovascular Medicine, University of Leeds, United Kingdom

              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 to standard exercise tolerance testing (ETT).

              Design Cross sectional, observational study.

              Setting University teaching hospital.

              Patients Thirty-five 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 terms of identifying patients with significant coronary stenosis (≥70%) and the necessity for coronary revascularisation. Also, to determine if CMR can distinguish between ischaemia in the peri-infarct zone and ischemia 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) to detect significant coronary stenosis and more sensitive to predict revascularisation (94% vs. 56%, p=0.039). Inducible ischemia in the infarct related artery (IRA) 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.

              • Magnetic resonance imaging
              • coronary heart disease
              • myocardial infarction
              • myocardial ischemia
              • myocardial perfusion

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