Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in wome
- PDF / 463,386 Bytes
- 9 Pages / 595.28 x 793.7 pts Page_size
- 56 Downloads / 182 Views
RESEARCH
Open Access
Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women Simon Greulich1*, Oliver Bruder2, Michele Parker3, Julia Schumm1, Stefan Grün1, Steffen Schneider2, Igor Klem3, Udo Sechtem1 and Heiko Mahrholdt1
Abstract Background: Exercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed. Methods and results: We prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA. Exercise ECG, CMR and CA was completed in 68 females (age 66.4 ± 8.8 years, number of CAD risk factors 3.5 ± 1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was −3.0 ± 5.4 and was similar in those with and without CAD (−4.5 ± 5.8 and −2.4 ± 5.1; P = 0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P = 0.02, specificities 94% and 73%, P = 0.01, and accuracies 91% and 66%, P = 0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94 ± 0.03 vs 0.56 ± 0.07; P = 0.0001). Conclusions: In women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.
Background Coronary artery disease (CAD) is the leading cause of morbidity and mortality in women [1]. The assessment of CAD in women is challenging compared with men for several reasons. The clinical presentation is often with atypical symptoms and the predictive power of traditional cardiac risk factors is different in women compared to men [2]. Based on assessment of symptoms and risk factors, the majority of women being evaluated for chest pain syndromes have an intermediate pre-test probability of CAD. In this group of patients accurate noninvasive tests are an indispensable component in the * Correspondence: [email protected] 1 Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany Full list of author information is available at the end of the article
diagnostic work-up [3]. However, well-established noninvasive tests for the diagnosis of CAD all have substantial limitations in women in predicting significant angiographic CAD [4]. Furthermore, the prevalence of CAD in women presenting with chronic anginal pain as well as acute coronary syndromes i
Data Loading...
