Abstract 14229: Diagnostic Accuracy Of Adenosine Stress Cardiac MRI (CMR) Following Acute ST Elevation Myocardial Infarction Post Primary Angioplasty
Background: Adenosine stress cardiac MRI (CMR) has been proven an effective tool in detection of reversible ischaemia following thrombolytic therapy for ST segment elevation myocardial infarction (STEMI). Its effectiveness in detecting ischemia in non culprit stenosis post primary percutaneous coronary intervention (PPCI) is unknown. We sought to determine the safety and diagnostic accuracy of adenosine stress CMR in detecting ischemia in non culprit territory lesions early after PPCI for STEMI. We also hypothesise that semi quantitative assessment of CMR is more accurate than visual analysis.
Methods: Fifty STEMI patients, (age 59 ± 12 years), who had successful PPCI were prospectively enrolled in a CMR imaging protocol with rest and adenosine stress perfusion, viability and cardiac functional assessment. Three short axis slices each divided into 6 segments on first pass adenosine perfusion were visually and semi-quantitatively analysed. For semi-quantitative assessment each segment subendocardial myocardial perfusion reserve index (MPRI) was calculated by using the upslope of the signal-intensity time curve of stress and rest images. MPRI in a vascular region of <1.1 was taken as significant as previously described. Diagnostic accuracy of both methods was compared with non-culprit-territory stenosis utilising quantitative coronary angiography (QCA) with significant stenosis defined as ≥70%.
Results: CMR imaging was well tolerated (all patients completed the protocol) and no significant complications occurred. STEMI group included 41% anterior, 59% non anterior STEMI. There were a total of 100 non culprit territory lesions. Semi quantitative analysis was more accurate in detecting non culprit territory stenosis compared to visual analysis.
Conclusions: Adenosine stress CMR, particularly semi quantitative analysis,can accurately detect non culprit territory stenosis post STEMI.
- © 2010 by American Heart Association, Inc.