Prognostic value of adenosine stress cardiovascular magnetic resonance and dobutamine stress echocardiography in patients with low-risk chest pain

  • Gregory Hartlage
  • Matthew Janik
  • Athanasios Anadiotis
  • Emir Veledar
  • John Oshinski
  • Dimitrios Kremastinos
  • Arthur Stillman
  • Stamatios Lerakis
Original Paper

Abstract

Excluding obstructive coronary artery disease (CAD) as the etiology of acute chest pain in patients without diagnostic electrocardiographic changes or elevated serum cardiac biomarkers is challenging. Stress testing is a valuable risk-stratifying technique reserved for the subset of these patients with low-risk chest pain who have an intermediate clinical probability of obstructive CAD. Given the risks of radiation inherent to nuclear and computed tomography imaging, both adenosine stress cardiovascular magnetic resonance (AS-CMR) imaging and dobutamine stress echocardiography (DSE) are attractive alternative stress modalities. An essential characteristic of stress modalities is their negative prognostic value; as one must exclude clinically-relevant CAD such that patients can be discharged safely. Therefore, the aim of this study was to validate a favorable negative prognostic value for both AS-CMR and DSE in patients presenting with low-risk acute chest pain. This retrospective study included 255 patients with low-risk acute chest pain and no prior history of CAD presenting to the emergency department at our institution, with 89 patients evaluated by AS-CMR and 166 by DSE. Median follow-up was 292 days, and consisted of medical record review. The primary end-point was the composite of cardiac death, nonfatal acute myocardial infarction, obstructive CAD on invasive coronary angiography (ICA) or recurrent chest pain requiring hospital admission. Test characteristics such as sensitivity and specificity could not be evaluated as patients were not routinely evaluated with ICA. All patients completed the stress protocol without adverse events during testing. 82/89 patients (92.1%) and 164/166 patients (98.8%) had negative AS-CMR and DSE studies, respectively. Both AS-CMR and DSE had excellent negative prognostic values for the primary endpoint, 100 and 99%, respectively. Both AS-CMR and DSE are effective stress modalities for excluding clinically significant coronary artery disease in patients presenting acute low-risk chest pain. Patients without findings to suggest ischemia have an excellent intermediate-term prognosis.

Keywords

Adenosine Stress Cardiac magnetic resonance Dobutamine stress echocardiogram Chest pain Prognostic value 

Abbreviations

AS-CMR

Adenosine-stress cardiovascular magnetic resonance imaging

DSE

Dobutamine stress echocardiography

CAD

Coronary artery disease

ICA

Invasive coronary angiography

EKG

Electrocardiogram

CDU

Clinical decision unit

LGE

Late gadolinium enhancement

SPECT

Single photon emission tomography

PET

Positron emission tomography

SSFP

Steady-state free procession

THR

Target heart rate

Notes

Conflict of interests

The authors declare that they have no competing interests.

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Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Gregory Hartlage
    • 1
  • Matthew Janik
    • 1
  • Athanasios Anadiotis
    • 1
  • Emir Veledar
    • 1
  • John Oshinski
    • 2
  • Dimitrios Kremastinos
    • 3
  • Arthur Stillman
    • 2
  • Stamatios Lerakis
    • 1
    • 2
    • 3
  1. 1.Department of Medicine and Division of CardiologyEmory University School of MedicineAtlantaUSA
  2. 2.Department of RadiologyEmory University School of MedicineAtlantaUSA
  3. 3.Department of CardiologyAttikon General University HospitalAthensGreece

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