Head to Head Comparison Between Perfusion and Function During Accelerated High-Dose Dipyridamole Magnetic Resonance Stress for the Detection of Coronary Artery Disease

      The aim of this study was to compare the diagnostic accuracy of perfusion and wall motion (WM) during dipyridamole magnetic resonance in patients with chest pain syndrome. Ninety-three patients with normal baseline left ventricular function were referred for coronary angiography. Additional dipyridamole stress magnetic resonance testing (0.84 mg/kg over 6 minutes; using a Signa Cvi scanner) was performed. Cardiac-gated fast gradient-echo train sequences with a first pass of gadolinium contrast medium were used to assess myocardial perfusion. A perfusion reserve index was calculated as the ratio of dipyridamole to rest upslope. A perfusion reserve index value <1.54 in 2 contiguous myocardial segments was the perfusion positivity criterion. The WM positivity criterion was a segmental score increase of ≥1 grade in ≥2 segments. WM and the perfusion reserve index showed similar diagnostic accuracy for >50% quantitatively assessed coronary diameter reduction (86% for both), with WM having higher specificity (96% vs 66%, p <0.01) and lower sensitivity (82% vs 93%, p <0.05) than the perfusion reserve index. Perfusion had the highest accuracy values for coronary stenoses <75% (cutoff 59%) and WM for coronary stenoses ≥75% (cutoff 84%) (p <0.001). In conclusion, during dipyridamole magnetic resonance stress testing, perfusion and WM abnormalities have similar diagnostic accuracy, with perfusion showing higher sensitivity, particularly in the detection of moderate stenoses, and WM showing higher specificity.
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        • Picano E.
        Dipyridamole echocardiography test: historical background and physiologic basis.
        Eur Heart J. 1989; 10: 365-376
        • Fox K.
        • Garcia M.A.
        • Ardissino D.
        • Buszman P.
        • Camici P.G.
        • Crea F.
        • Daly C.
        • De Backer G.
        • Hjemdahl P.
        • Lopez-Sendon J.
        • et al.
        Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology; ESC Committee for Practice Guidelines (CPG).
        Eur Heart J. 2006; 27: 1341-1381
        • Pingitore A.
        • Picano E.
        • Quarta Colosso M.
        • Reisenhofer B.
        • Gigli G.
        • Lucarini A.
        • Petix N.
        • Previtali M.
        • Bigi R.
        • Chiarandà G.
        • et al.
        The atropine factor in pharmacologic stress echocardiography.
        J Am Coll Cardiol. 1996; 27: 1164-1170
        • Picano E.
        Stress echocardiography: a historical perspective.
        Am J Med. 2003; 114: 126-130
        • Dal Porto R.
        • Faletra F.
        • Picano E.
        • Pirelli S.
        • Moreo A.
        • Varga A.
        Safety, feasibility and diagnostic accuracy of accelerated high dose dipyridamole stress echocardiography.
        Am J Cardiol. 2001; 87: 520-524
        • Paetsch I.
        • Jahnke C.
        • Wahl A.
        • Gebker R.
        • Neuss M.
        • Fleck E.
        • Nagel E.
        Comparison of dobutamine stress magnetic resonance, adenosine stress magnetic resonance, and adenosine stress magnetic resonance perfusion.
        Circulation. 2004; 110: 835-842
        • Schwitter J.
        • Bauer W.
        • van Rossum A.C.
        • Lombardi M.
        • Al-Saadi N.
        • Flamm S.
        • Marquardt M.
        • Johannson L.
        Comparison of MR perfusion imaging with single photon emission computed tomography: a multicenter multivendor dose finding study.
        Eur Heart J. 2005; 326: 329
        • Diamond G.A.
        • Forrester J.S.
        Analysis of probability as an aid in the clinical diagnosis of coronary artery disease.
        N Engl J Med. 1979; 300: 1350-1358
        • Schwitter J.
        • Nanz D.
        • Kneifel S.
        • Bertschinger K.
        • Buchi M.
        • Knusel P.R.
        • Marincek B.
        • Luscher T.F.
        • von Schulthess G.K.
        Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography.
        Circulation. 2001; 103: 2230-2235
        • Cerqueira M.D.
        • Weissman N.J.
        • Dilsizian V.
        • Jacobs A.K.
        • Kaul S.
        • Laskey W.K.
        • Pennell D.J.
        • Rumberger J.A.
        • Ryan T.
        • Verani M.S.
        • American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging
        Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.
        Circulation. 2002; 105: 539-542
        • Positano V.
        • Pingitore A.
        • Scattini B.
        • Santarelli M.F.
        • De Marchi D.
        • Favilli B.
        • Lombardi M.
        • Landini L.
        Myocardial perfusion by first pass contrast magnetic resonance: a robust method for quantitative regional assessment of perfusion reserve index.
        Heart. 2006; 92: 689-690
        • Rigo F.
        • Gherardi S.
        • Galderisi M.
        • Sicari R.
        • Picano E.
        The independent prognostic value of contractile and coronary flow reserve determined by dipyridamole stress echocardiography in patients with idiopathic dilated cardiomyopathy.
        Am J Cardiol. 2007; 99: 1154-1158
        • Gibbons R.J.
        • Abrams J.
        • Chatterjee K.
        • Daley J.
        • Deedwania P.C.
        • Douglas J.S.
        • Ferguson T.B.
        • Fihn S.D.
        • Fraker T.D.
        • Gardin J.M.
        • et al.
        ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).
        J Am Coll Cardiol. 2003; 41: 159-168
        • O’Keefe J.H.
        • Barnhart C.S.
        • Bateman T.M.
        Comparison of stress echocardiography and stress myocardial perfusion scintigraphy for diagnosing coronary artery disease and assessing its severity.
        Am J Cardiol. 1995; 75: 25D-34D
        • Lee T.H.
        • Boucher C.A.
        Noninvasive tests in patients with stable coronary artery disease.
        N Engl J Med. 2001; 344: 1840-1845
        • Picano E.
        • Palinkas A.
        • Amyot R.
        Diagnosis of myocardial ischemia in hypertensive patients.
        J Hypertens. 2001; 19: 1177-1183
        • Rigo F.
        Coronary flow reserve in stress-echo lab.
        Cardiovasc Ultrasound. 2005; 3: 8
        • Hutchinson S.J.
        • Shen A.
        • Soldo S.
        • Hla A.
        • Kawanishi D.T.
        • Chandrartna P.A.
        Transesophageal assessment of coronary flow velocity reserve during “regular” and “high”-dose dipyridamole stress testing.
        Am J Cardiol. 1996; 77: 1164-1168
        • Salustri A.
        • Fioretti P.M.
        • McNeill A.J.
        • Pozzoli M.M.
        • Roelandt J.R.
        Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischaemia: a comparison between dobutamine and dipyridamole.
        Eur Heart J. 1992; 13: 1356-1362
        • Nedeljkovic I.
        • Ostojic M.
        • Beleslin B.
        • Djordievic-Dikic A.
        • Stepanovic J.
        • Nedeljkovic M.
        • Stojkovic S.
        • Stankovic G.
        • Saponjski J.
        • Petrasinovic Z.
        • et al.
        Comparison of exercise, dobutamine atropine and dipyridamole-atropine stress echocardiography in detecting coronary artery disease.
        Cardiovasc Ultrasound. 2006; 3: 4-22
        • San Roman J.A.
        • Vilacosta I.
        • Castillo J.A.
        • Rollan M.J.
        • Hernandez M.
        • Peral V.
        • Garcimartin I.
        • de la Torre M.M.
        • Fernandez Aviles F.
        Selection of the optimal stress test for the diagnosis of coronary artery disease.
        Heart. 1998; 80: 370-376
        • Picano E.
        Dipyridamole in myocardial ischemia: good Samaritan or terminator?.
        Int J Cardiol. 2002; 83: 215-216
        • Djordjevic-Dikic A.D.
        • Ostojic M.
        • Beleslin B.
        • Stepanovic J.
        • Petrasinovic Z.
        • Babic R.
        • Stojkovic S.
        • Stankovic G.
        • Nedeljkovic M.
        • Nedeljkovic I.
        • Kanjuh V.
        High dose adenosine stress echocardiography for non-invasive detection of coronary artery disease.
        J Am Coll Cardiol. 1996; 28: 1689-1695
        • Lattanzi F.
        • Picano E.
        • Bolognese L.
        • Piccinino C.
        • Sarasso G.
        • Orlandini A.
        • L’Abbate A.
        Inhibition of dipyridamole-induced ischemia by antianginal therapy in humans.
        Circulation. 1991; 83: 1256-1262
        • Sicari R.
        • Cortigiani L.
        • Bigi R.
        • Landi P.
        • Raciti M.
        • Picano E.
        • Echo-Persantine International Cooperative (EPIC) Study Group
        Prognostic value of pharmacological stress echocardiography is affected by concomitant antiischemic therapy at the time of testing.
        Circulation. 2004; 109: 2428-2431