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
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Figure 1 Receiver-Operator Characteristic Curves
Receiver-operator characteristic curve analysis comparing the combined perfusion and delayed enhancement cardiovascular magnetic resonance (DE-CMR) stress test using the interpretation algorithm to perfusion CMR alone for the detection of coronary artery disease. The diagnostic accuracy of the combined CMR stress test was significantly greater (p = 0.002). AUC = area under curve.
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Figure 2 Patient Examples of CMR Stress Test in Women
Patient #1 is a 70-year-old, post-menopausal woman with typical angina and 3 coronary artery disease (CAD) risk factors. There is no evidence of prior infarction on delayed-enhancement (DE) images; however, stress perfusion indicates defects in all 3 vascular territories. Coronary angiography demonstrated 3-vessel coronary disease. Patient #2 is a 50-year-old, post-menopausal woman without chest pain. However, she has diabetes, hypertension, hyperlipidemia, and a positive family history for CAD. A reversible perfusion defect was noted, which was not confined to 1 coronary territory. Her coronary angiogram revealed no epicardial disease, thus microvascular disease may be suspected in this patient. Patient #3 is a 63-year-old woman with typical angina but no prior history of myocardial infarction. She is also post-menopausal and has 3 CAD risk factors. On DE-cardiovascular magnetic resonance (CMR), a transmural infarct is noted in the territory of the right coronary artery (RCA), with a corresponding dense perfusion defect in the same location. However, her coronary angiogram demonstrated only a 40% stenosis in the RCA. Although this was a false-positive CMR study, secondary CAD prevention therapy is certainly warranted in this woman. LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery.
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