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Journal of Cardiovascular Magnetic Resonance

, 11:37

First Online: 21 September 2009Received: 19 May 2009Accepted: 21 September 2009


BackgroundApproximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance AS-CMR is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients.

MethodsWe studied 103 patients, mean 56.7 ± 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress adenosine and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 range 161-462 days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease >50% coronary stenosis on invasive angiography and coronary revascularization.

ResultsIn 14 patients 13.6%, AS-CMR was positive. The remaining 89 patients 86.4%, who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary end-point during follow-up. The negative predictive value of AS-CMR was 100%.

ConclusionAS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-11-37 contains supplementary material, which is available to authorized users.

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Autor: Stamatios Lerakis - Dalton S McLean - Athanasios V Anadiotis - Matthew Janik - John N Oshinski - Nikolaos Alexopoulos - E


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