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Value of Cardiovascular Magnetic Resonance Stress Perfusion Testing for the Detection of Coronary Artery Disease in Women

Igor Klem, MD^_*,_*, Simon Greulich, MD, John F. Heitner, MD, Han Kim, MD^_*, Holger Vogelsberg, MD, Eva-Maria Kispert, Srivani R. Ambati, MD^_*, Christian Bruch, MD, Michele Parker, RN, MS^_*, Robert M. Judd, PhD^_*, Raymond J. Kim, MD, FACC^_*, Udo Sechtem, MD, FACC

^_* Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina
Robert-Bosch-Krankenhaus, Stuttgart, Germany
New York Methodist Hospital, New York, New York
Kliniken Miltenberg-Erlenbach GmbH

^_* Reprint requests and correspondence: Dr. Igor Klem, Duke Cardiovascular MRI Center, DUMC-3934, Durham, North Carolina 27710. (Email: igor.klem{at}duke.edu).

Objectives: We wanted to assess the value of cardiovascular magnetic resonance (CMR) stress testing for evaluation of women with suspected coronary artery disease (CAD).

Background: A combined perfusion and infarction CMR examination can accurately diagnose CAD in the clinical setting in a mixed gender population.

Methods: 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 70% on quantitative analysis of coronary angiography.

Results: 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 50% vs. 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 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 1.15 g/ml vs. >1.15 g/ml).

Conclusions: 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.

Key Words: CAD • women • stress CMR

Abbreviations and Acronyms   CA = coronary angiography   CAD = coronary artery disease   CMR = cardiovascular magnetic resonance   DE-CMR = delayed-enhancement cardiovascular magnetic resonance   LV = left ventricular   MI = myocardial infarction   RBK = Robert-Bosch-Krankenhaus   SPECT = single-photon emission computed tomography

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