Klem Igor, Greulich Simon, Heitner John F, Kim Han, Vogelsberg Holger, Kispert Eva-Maria, Ambati Srivani R, Bruch Christian, Parker Michele, Judd Robert M, Kim Raymond J, Sechtem Udo
Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina 27710, USA.
JACC Cardiovasc Imaging. 2008 Jul;1(4):436-45. doi: 10.1016/j.jcmg.2008.03.010.
We wanted to assess the value of cardiovascular magnetic resonance (CMR) stress testing for evaluation of women with suspected coronary artery disease (CAD).
A combined perfusion and infarction CMR examination can accurately diagnose CAD in the clinical setting in a mixed gender population.
We prospectively enrolled 147 consecutive women with chest pain or other symptoms suggestive of CAD at 2 centers (Duke University Medical Center, Robert-Bosch-Krankenhaus). Each patient underwent a comprehensive clinical evaluation, a CMR stress test consisting of cine rest function, adenosine-stress and rest perfusion, and delayed-enhancement CMR infarction imaging, and X-ray coronary angiography within 24 h. The components of the CMR test were analyzed visually both in isolation and combined using a pre-specified algorithm. Coronary artery disease was defined as stenosis > or =70% on quantitative analysis of coronary angiography.
Cardiovascular magnetic resonance imaging was completed in 136 females (63.0 +/- 11.1 years), 37 (27%) women had CAD on coronary angiography. The combined CMR stress test had a sensitivity, specificity, and accuracy of 84%, 88%, and 87%, respectively, for the diagnosis of CAD. Diagnostic accuracy was high at both sites (Duke University Medical Center 82%, Robert-Bosch-Krankenhaus 90%; p = 0.18). The accuracy for the detection of CAD was reduced when intermediate grade stenoses were included (82% vs. 87%; p = 0.01 compared the cutoff of stenosis > or =50% vs. > or =70%). The sensitivity was lower in women with single-vessel disease (71% vs. 100%; p = 0.06 compared with multivessel disease) and small left ventricular mass (69% vs. 95%; p = 0.04 for left ventricular mass < or =97 g vs. >97 g). The latter difference was even more significant after accounting for end-diastolic volumes (70% vs. 100%; p = 0.02 for left ventricular mass indexed to end-diastolic volume < or =1.15 g/ml vs. >1.15 g/ml).
A multicomponent CMR stress test can accurately diagnose CAD in women. Detection of CAD in women with intermediate grade stenosis, single-vessel disease, and with small hearts is challenging.
我们旨在评估心血管磁共振（CMR）负荷试验对疑似冠心病（CAD）女性患者的评估价值。
灌注与梗死联合CMR检查能够在临床环境中准确诊断混合性别群体中的CAD。
我们前瞻性地纳入了2个中心（杜克大学医学中心、罗伯特 - 博世医院）连续的147例有胸痛或其他提示CAD症状的女性患者。每位患者均接受了全面的临床评估、CMR负荷试验，包括电影静息功能、腺苷负荷及静息灌注以及延迟强化CMR梗死成像，并在24小时内进行了X线冠状动脉造影。CMR检查的各个组成部分分别及联合使用预先指定的算法进行视觉分析。冠状动脉疾病定义为冠状动脉造影定量分析显示狭窄≥70%。
136名女性（63.0±11.1岁）完成了心血管磁共振成像，37名（27%）女性冠状动脉造影显示患有CAD。联合CMR负荷试验对CAD诊断的敏感性、特异性和准确性分别为84%、88%和87%。两个中心的诊断准确性均较高（杜克大学医学中心82%，罗伯特 - 博世医院90%；p = 0.18）。当纳入中度狭窄时，CAD检测的准确性降低（82%对87%；与狭窄≥50%对比狭窄≥）。单支血管病变女性的敏感性较低（71%对100%；与多支血管病变相比，p = 0.06），左心室质量较小的女性敏感性也较低（69%对95%；左心室质量≤97 g对比＞97 g，p = 0.04）。在考虑舒张末期容积后，后者的差异更为显著（70%对100%；左心室质量指数与舒张末期容积≤1.15 g/ml对比＞1.15 g/ml，p = 0.02）。
多组分CMR负荷试验能够准确诊断女性CAD。对于中度狭窄、单支血管病变及心脏较小的女性患者，CAD的检测具有挑战性。
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