冠状动脉双源CT与冠状动脉造影成像对急诊胸痛患者诊断冠心病的价值

目的:以常规冠状动脉造影(CAG)为"金标准",探讨急诊胸痛患者双源CT(DSCT)冠状动脉血管成像诊断冠心病的价值,分析DSCT诊断冠心病的准确度、灵敏度、特异度、阳性预测值和阴性预测值。方法:对115例以胸痛为主诉的急诊就诊、临床怀疑冠心病拟行CAG的患者[男60例,女55例,平均年龄(66.37±10.29)岁]进行DSCT冠状动脉成像,统计分析DSCT对诊断冠状动脉不同程度狭窄冠心病的准确度、灵敏度及特异度,并与CAG结果对比。结果:共获得92例有诊断价值的病例,DSCT诊断冠状动脉中重度狭窄的准确度为94.6%,灵敏度、特异度、阳性预测值和阴性预测值分别为96.7%、90.6%、95.1%和93.5%。对于诊断轻度狭窄冠心病的灵敏度为70.6%,特异度为63.9%,阳性预测值为34.3%,阴性预测值为91.2%。结论:DSCT冠状动脉成像可作为临床冠心病可疑患者CAG手术前的预筛手段,当患者的冠状动脉为中重度狭窄时,诊断的准确度、灵敏度、特异度较高,DSCT与CAG有很好的一致性,其对是否需进一步CAG检查有较大的指导意义。DSCT对于冠状动脉轻度狭窄患者的阴性预测值较高,提示如果DSCT判定患者无冠状动脉病变,基本上无进一步行CAG的必要。     

心电图与冠状动脉造影诊断冠心病的临床分析

目的探讨心电图与冠状动脉造影对诊断冠心病的临床价值.方法观察575例临床诊断为冠心病的病人,均行18导联心电图(ECG)检查并行冠状动脉造影(CAG)检查.结果575例病人中有392例病人CAG阳性,临床符合率68.2%.ECG检查冠心病的灵敏度为76.9%,特异度为34.9%.心电图ST-T改变伴典型胸痛病人,CAG阳性率85.1%,心电图ST-T改变伴不典型胸痛病人,CAG阳性率43.3%,典型胸痛无心电图ST-T改变,CAG阳性率74.7%,不典型胸痛无心电图ST-T改变,CAG阳性率35.8%.结论典型胸痛伴心电图ST-T改变,对冠心病的诊断价值要优于不典型胸痛伴心电图ST-T改变,无心电图ST-T改变的典型胸痛病人不能排除冠心病,CAG检查可避免ECG检查对冠心病诊断造成的误诊、漏诊.     

心电图与冠状动脉造影诊断冠心病的对比分析

为探讨心电图在诊断冠心病中的价值 ,15 6例临床诊断冠心病的患者 ,均记录 18导联心电图 (ECG) ,继之行冠状动脉造影(CAG) ,部分患者同时接受冠状动脉内介入治疗。结果 :心电图诊断冠心病的灵敏度为 78.6% ,特异度 3 6.1% ,假阳性率 63 .9% ,假阴性率 19.7% ,阳性预测值 5 8.9% ,阴性预测值 5 9.1%。CAG前ECG有缺血性改变的患者中 ,CAG未见明显管腔狭窄占 43 .4% ( 4 9/ 113 ) ;临床有发作性胸痛 ,ECG无缺血性改变的患者中 ,CAG显示相应血管有粥样硬化狭窄者 40 % ( 17/ 42 ) ;CAG显示三支血管病变 ,ECG无缺血性改变的占 19.4% ( 7/ 3 6)。结论 :心电图是诊断冠心病的有效手段 ,但有一定的局限性 ,应重视CAG检查。     

头胸导联心电图对冠心病诊断价值的分层分析

目的 :分层分析比较头胸导联心电图 （头胸 ECG）和常规导联心电图 （常规 ECG）对冠心病的诊断价值。方法 :对 110例行选择性冠状动脉造影 （CAG）的疑诊冠心病患者 ,使用头胸导联心电图机和常规导联心电图机非同步记录头胸 ECG和常规 ECG图形 ,由专业人员盲法分析其结果 ,并对结果进行进一步的分层分析 ,评价二种方法对冠心病的诊断价值。结果 :头胸 ECG诊断冠心病的灵敏度、特异度和准确度分别为 72 % ,50 % ,69%。常规 ECG诊断冠心病的灵敏度、特异度和准确度分别为 45% ,43 % ,45%。头胸 ECG诊断冠心病的灵敏度、准确度均显著高于常规 ECG（均为 P<0 .0 1） ,二者诊断冠心病的特异度无显著性差异 （P>0 .0 5）。分层分析显示头胸 ECG及常规 ECG对冠心病诊断的灵敏度与冠状动脉病变的程度、范围显著相关 ,头胸 ECG对右室心肌缺血诊断优于常规 ECG。结论 :头胸 ECG诊断冠心病较常规 ECG更有价值     

头胸导联心电图诊断冠心病的价值

目的 :比较 Wilson导联心电图 （常规 ECG）和头胸导联心电图 （HCECG）对冠心病的诊断价值。方法 :在 14 3例经选择性冠状动脉造影 （CAG）患者中 ,确诊的冠心病患者 12 9例 .分别使用常规心电图机和头胸导联心电图机非同步记录常规 ECG和 HCECG图形 ,由专业人员盲法分析其结果 ,评价二种方法对冠心病的诊断价值。结果 :常规 ECG诊断冠心病的灵敏度、特异度和准确度分别为 5 9% ,5 7% ,5 7%。HCECG诊断冠心病的灵敏度、特异度和准确度分别为 79% ,5 0 % ,76 %。HCECG均显著高于常规 ECG（P<0 .0 1）。结论 :HCECG对冠心病的诊断价值明显高于常规 ECG。     

心电图、超声在老年左室壁肥厚诊断中准确率、灵敏度、特异度的比较

目的 对比分析心电图(ECG)、超声在老年左室壁肥厚诊断中的准确率、灵敏度、特异度。方法 100例老年心脏病患者分别给予ECG、超声检查，将冠状动脉造影(CAG)作为金标准，比较ECG、超声诊断准确率、灵敏度、特异度，Kappa检验ECG、超声与CAG的一致性，比较左室壁肥厚组、非左室壁肥厚组心脏超声参数。结果 超声诊断左室壁肥厚准确率、灵敏度显著高于ECG(P<0.05),超声诊断左室壁肥厚特异度与ECG比较，差异无统计学意义(P>0.05),Kappa检验ECG与CAG的一致性一般(Kappa值=0.596,P<0.05),超声与CAG的一致性较好(Kappa值=0.781,P<0.05)。左室壁肥厚组左室重量、左室舒张末期内径(LVDD)、舒张末期左心室后壁厚度(LVPWD)、舒张末期室间隔厚度(IVSd)均显著高于非左室壁肥厚组(P<0.05)。结论 超声可提高老年左室壁肥厚诊断准确率、灵敏度、特异度，同时提供LVDD、LVPWD等超声参数，辅助临床对左室壁肥厚程度作出评价。     

超声心动图室壁节段运动异常作为冠状动脉造影指征的探讨

目的:比较超声心动图(UCG)示室壁节段运动异常(RWMA)和冠状动脉造影(CAG)指征中的心电图(ECG)异常、症状与CAG结果的关系,并探讨其能否成为CAG的适应证。方法:术前按有无胸痛和(或)胸闷、ST-T等异常及RWMA分为症状、ECG、UCG的阳性组及其阴性组,以CAG结果作为标准,进行灵敏度、特异度、阳性预测值、假阳性率以及相对工作特征(ROC)曲线的计算与分析。结果:症状、ECG、UCG组的阳性预测值分别为64.7%、77.3%和86.6%;症状、ECG、UCG组的ROC曲线下面积分别为0.53、0.63和0.62,与0.5比较,P>0.05、<0.01、<0.01;3组比较,P<0.05,诊断效率差异有统计学意义。进一步两两比较,UCG与ECG差异无统计学意义(P>0.05),诊断效率相当;UCG、ECG分别与症状相比较,均差异有统计学意义(均P<0.05),诊断效率不相当;UCG与ECG诊断效率相当,但均比症状高。结论:UCG诊断RWMA可以作为CAG的适应证之一。     

胸痛患者心电图、超声心动图及冠状动脉造影的对比分析

目的 评价常规心电图(ECG)、超声心动图(UCG)及冠状动脉造影(CAG)对胸痛患者的诊断价值。方法分析84例具有冠心病危险因素及发作性胸痛患者的ECG、UCG及CAG资料,分别以ST—T异常、节段性室壁运动异常及冠状动脉狭窄为诊断标准。结果 70例典型胸痛者CAG阳性55例,14例非典型胸痛者无1例CAG阳性。以CAG阳性为依据,ECG的敏感性为72.7％,特异性为72.4％,UCG的敏感性为27.3％,特异性为86.2％。结论 临床上依据典型胸痛诊断冠心病的准确性较高,CAG阴性并不能排除冠心病。对于胸痛患者的诊断ECG仍是简便、可靠的诊断方法,常规UCG诊断胸痛患者的价值不大,临床上应积极开展超声心动图负荷试验以提高其诊断价值。     

动态心电图在冠心病无症状性心肌缺血诊断中的效果

目的探讨动态心电图在冠心病无症状性心肌缺血诊断中的临床效果。方法选取52例2017年2月-2019年6月在我院诊断的冠心病患者,对其均行冠脉造影诊断,并将此作为诊断金标准,再行动态心电图诊断和常规心电图检查,观察并比较动态心电图和常规心电图诊断的特异度、灵敏度以及准确度。结果动态心电图检查的敏感度(89.29%)高于常规心电图(74.07%),差异不明显(P>0.05),但是动态心电图检查的特异度(84.21%)、准确度(78.85%)等均高于常规心电图的63.16%、61.54%,差异明显(P<0.05),有统计学意义。结论诊断人员采用动态心电图对冠心病无症状性心肌缺血患者进行诊断,具有较高的灵敏度、特异度和准确度,能够为临床治疗提供指导性的依据,有较高的推广价值。     

静息心电图与二维超声心动图对冠心病诊断的对比研究

目的评价常规静息心电图(ECG)与二维超声心动图(2D-UCG)对冠心病的诊断价值。方法ECG,2D-UCG和冠状动脉造影(CAG)分别以ST-T异常、节段性室壁运动异常及冠状动脉主要分支固定狭窄≥50%为诊断标准,将77例有发作性胸痛并拟诊冠心病病人的ECG,2D-UCG资料与CAG结果对比分析。结果77例胸痛病人CAG阳性53例,CAG阴性24例。ECG敏感性88.7%,特异性66.7%;2D-UCG敏感性58.5%,特异性83.3%。结论ECG仍是简便和较为敏感的诊断方法,2D-UCG诊断冠心病敏感性较低而特异性较高,二者结合有助于提高对冠心病的诊断价值。     

Magnetocardiography Predicts Coronary Artery Disease in Patients with Acute Chest Pain

Background: The value of magnetocardiography (MCG) for the detection of cardiac electrical disturbances associated with myocardial ischemia was studied. Methods: Sensitivity and predictivity of admission MCG for the presence of coronary artery disease (CAD) were prospectively evaluated in 264 consecutive patients presenting with acute chest pain and without ST‐segment elevation. MCG findings were compared with 12‐lead ECG, echocardiography (ECHO), and troponin‐I in a head‐to‐head design. Coronary angiography was used for CAD diagnosis. Results: The visual assessment of magnetocardiograms by the experienced reader (R1) was superior to that by the unexperienced reader (R2) and superior to the automated computer analysis. Specificity and positive predictive value of MCG by R1 were comparable with those of ECG and troponin‐I (>90%), while ECHO specificity and ECHO positive predictive value were lower (76.2% and 87.9%, respectively). Sensitivity and negative predictive value of MCG were twice as high as those in the ECG, troponin‐I, and ECHO tests. Conclusion: For the prediction of CAD in patients presenting with acute chest pain and without ST‐segment elevation, an admission MCG test was superior to an admission ECG, ECHO, and troponin‐I. The results of the study, however, are applicable only to a highly selected population comprising patients in whom immediate coronary angiography can be performed based on their clinical course in the hospital.     

Evaluation of Non-ST Segment Elevation Acute Chest Pain Syndromes with a Novel Low-Profile Continuous Imaging Ultrasound Transducer

Background: This investigation was designed to test the hypothesis that continuous cardiac imaging using an ultrasound transducer developed in our laboratory (ContiScan) is superior to electrocardiogram (ECG) monitoring in the diagnosis of coronary artery disease (CAD) in patients with acute non-ST segment elevation chest pain syndromes. Methods: Seventy patients with intermediate to high probability of CAD who presented with typical anginal chest pain and no evidence of ST segment elevation on the ECG were studied. The 2.5-MHz transducer is spherical in its distal part mounted in an external housing to permit steering in 360 degrees. The transducer was placed at the left sternal border to image the left ventricular short-axis view and recorded on video tape at baseline, during and after episodes of chest pain. Two ECG leads were continuously monitored. The presence of CAD was confirmed by coronary arteriography or nuclear or echocardiographic stress testing. Results: Twenty-four patients had regional wall motion abnormalities (RWMA) on their initial echo which were unchanged during the period of monitoring. All had evidence of CAD. Twenty-eight patients had transient RWMA. All had evidence of CAD. Eighteen patients had normal wall motion throughout the monitoring period, 14 of these had no evidence of CAD, and four had evidence of CAD. These four patients did not have chest pain during monitoring. The sensitivity, specificity, and accuracy of echocardiographic monitoring for diagnosing non-ST elevation myocardial infarction was 88%, 100%, and 91% respectively. The sensitivity, specificity, and accuracy of the ECG for diagnosis of CAD were 31%, 100%, and 52%, respectively. Echocardiography was superior to ECG (P < 0.001). Conclusions: The data indicate that continuous cardiac imaging is superior to ECG monitoring for the diagnosis of CAD in patients presenting with acute non-ST segment elevation chest pain syndromes. This technique could be a useful adjunct to ECG monitoring for myocardial ischemia in the acute care setting.     

Resting Magnetocardiography Predicts 3‐Year Mortality in Patients Presenting with Acute Chest Pain without ST Segment Elevation

Objective: Magnetocardiography (MCG) as a noninvasive, noncontact and risk‐free diagnostic method predicts ischemic coronary artery disease (CAD) in patients with acute chest pain at admission with high accuracy. However, it remains unclear whether MCG findings can add prognostic information. Method: A cohort of 402 consecutive patients presenting at the intensive care unit (ICU) with acute chest pain without ST segment elevation (NSTEMI) were included in a prospective registry. In order to prove the prognostic value of MCG a head‐to‐head comparison of the admission MCG, ECG, TnI, and ECHO tests was made. Results: In 43 patients (10.7%) the MCG could not be analyzed due to insufficient signal‐to‐noise ratio. Complete follow‐up over a period of up to 3 years was obtained in 355 out of the 359 patients (98.9%). Age at admission was 67.2 ± 10.3 years, 59.7% males. In the group of patients with an abnormal MCG at admission, 43 out of 249 patients (17.3%) died in the follow‐up period, while in the group of patients with a normal MCG at admission only 4 out of 106 patients died (3.77%). The relative risk was 4.58 (95% confidence intervals: 1.68–12.42). A multivariate regression analysis revealed the highest mortality risk for patients with diabetes mellitus and an abnormal MCG at admission (RR = 18.0; 95% CI: 2.49–133.3). Conclusion: Resting MCG at hospital admission predicts 3‐year mortality in patients presenting with acute chest pain without ST segment elevation in the ECG. MCG seems to be valuable in identifying chest pain patients at highest risk.     

Coronary artery calcium by digital cinefluoroscopy in patients with pain suggestive of an acute coronary syndrome

BACKGROUND: Detection of coronary calcium may be a useful noninvasive approach for detecting coronary artery disease (CAD) in subjects presenting to the emergency department with chest pain. HYPOTHESIS: We tried to assess the diagnostic value of coronary artery calcium (CAC) detection by digital cinefluoroscopy in patients with new-onset chest pain suggestive of an acute coronary syndrome. METHODS: In 97 consecutive patients (70 men, 27 women, mean standard deviation [SD] age 55 (11) and 60 (8) years, respectively), with new-onset chest pain suggestive of an acute coronary syndrome, nondiagnostic electrocardiogram, and normal initial creatine kinase (CK)-MB, digital cinefluoroscopy was performed for CAC detection. RESULTS: All patients underwent routine clinical evaluation with treadmill exercise test, thallium scintigraphy, dobutamine stress echocardiography, and coronary angiography, as needed clinically and blinded to the cinefluoroscopy results. Coronary artery calcium was present in 27 of 33 (81.8%) of patients with and in 10 of 64 (15.6%) of patients without CAD, p < 0.0001. The presence of CAC had 82% sensitivity, 84% specificity, 73% positive predictive value, and 90% negative predictive value for CAD diagnosis (odds ratio = 24.3, 95% confidence interval 7.98-73.94). CONCLUSIONS: In patients with acute chest pain, nondiagnostic electrocardiogram and normal initial enzyme evaluation, CAC detection by digital cinefluoroscopy appears to have high sensitivity, specificity, and negative predictive value for CAD diagnosis.     

心电图正常或呈非特异性改变的冠心病患者心磁图分析

目的探讨心磁图(Magnetocardiography,MCG)对于静息心电图表现正常或呈非特异性改变的冠心病患者的诊断价值并筛选实用的诊断指标。方法采用德国Magscan公司生产无屏蔽式MCG-7记录仪,选择平均分级(averageclassificationoftotalmaps,ACTM)、异常心磁图所占百分比(ratioofabnormalmaps,RAM)、复合心室激动指数(complexventricularexcitationindex,CVEI)以及R波与T波的最大磁场值比值(Rmax/Tmax)四个分析指标,比较冠心病组(n=140,冠状动脉造影提示至少一支冠状动脉狭窄≥70%)与对照组(n=82例,冠状动脉造影显示冠状动脉完全正常)的MCG结果。结果冠心病组异常磁图的比例达到62%,多数电流密度图无明显双极对称结构,而对照组异常磁图的比例为35%,电流密度图有明显双极对称结构。冠心病组平均分级(2.62±0.98)显著高于对照组(2.29±0.90)。冠心病组的CVEI值位于异常区域(-100~0)内,而对照组CVEI值位于正常区域内(0~100)。Rmax/Tmax的比值在冠心病组高于对照组(6.41±3.29比4.10±2.00)。上述指标两组间差异均有统计学意义(P≤0.05)。通过受试者工作特征曲线(ROC曲线)分析表明,RAM、CVEI及Rmax/Tmax的诊断价值相对较高,敏感性分别为67.1%,65.9%及64.3%。特异性分别为65.1%,68.3%及68.3%。结论MCG对于静息心电图表现正常或呈非特异性改变者的慢性心肌缺血患者有独特的诊断价值,有利于冠心病的早期诊断。     

Non-invasive resting magnetocardiographic imaging for the rapid detection of ischemia in subjects presenting with chest pain

BACKGROUND: Early diagnosis of ischemia is complicated by the poor sensitivity of standard tests and contraindication for stress testing in unstable angina patients. Magnetocardiography (MCG) imaging can be used for the rapid, non-invasive detection of ischemia at rest. METHODS: We studied 125 patients with presumed ischemic chest pain. All were chest pain free at the time of scanning. A 6-minute resting MCG scan (CardioMag Imaging, Inc., New York, 9-channel system) was performed. Following the MCG scan, automated software data analysis was performed, and quantitative scores were automatically calculated for each subject. The presence of ischemia was determined after testing with serial troponins, stress testing, and/or coronary angiography. RESULTS: The mean age was 59.4 +/- 13.6 years. Most patients (86.4%) had non-ischemic 12-lead ECG and normal troponin (86.2%). Fifty-five patients (44.0%) were determined to be ischemic. The MCG sensitivity, specificity, positive and negative predictive value was 76.4, 74.3, 70.0 and 80.0%, respectively, for the detection of ischemia (p < 0.0001). CONCLUSIONS: MCG is a new rapid, non-invasive imaging tool able to detect repolarization abnormalities at rest consistent with ischemia in patients presenting with chest pain syndrome and normal or non-specific 12-lead ECG and normal troponin.     

Magnetocardiography for the Diagnosis of Coronary Artery Disease—A Systematic Review and Meta‐Analysis

Background: Coronary artery disease (CAD) has a significant disease burden making early diagnosis and management imperative. Magnetocardiography (MCG) is a relatively new noninvasive technique that allows diagnosis of CAD by recording the magnetic fields generated by the electrical activity of the heart. Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials for prospective studies that evaluated the test characteristics (e.g., sensitivity, specificity, likelihood ratios) of MCG for detection of CAD. Studies were included if they evaluated either patients with stable CAD documented by angiogram or patients presenting initially with acute coronary syndrome and subsequently diagnosed with CAD. The quality of included studies was assessed using an adaptation of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. We performed meta‐analyses of sensitivity, specificity and positive and negative likelihood ratios using Meta‐DiSc software. Results: Screening of titles and abstracts followed by full‐text review yielded seven studies that met our inclusion criteria. Meta‐analyses yielded a pooled sensitivity of 83% (95% confidence interval [CI] 80% to 86%) and a specificity of 77% (95% CI 73% to 81%). The pooled positive likelihood ratio was 3.92 (95% CI 2.30 to 6.66) and negative likelihood ratio was 0.20 (95% CI 0.12 to 0.35). Significant heterogeneity was present in all meta‐analyses. Conclusions: The pooled test characteristics for MCG are similar to those of existing noninvasive modalities for diagnosing CAD. Our results suggest that MCG is a potential complementary or alternative tool for noninvasive detection of CAD.     

Continuous 12-lead electrocardiographic monitoring in an emergency department chest pain unit: an assessment of potential clinical effect

STUDY OBJECTIVES: Continuous 12-lead serial ECG monitoring has been proposed to assist in the evaluation of patients with acute coronary syndrome and nondiagnostic ECG in an emergency department chest pain unit. However, the ability of serial ECG to detect acute coronary syndrome and its benefit in addition to a standard protocol has not been established. We evaluate the ability of continuous 12-lead ECG to detect acute coronary syndrome, assess the incremental benefit of the serial ECG in association with a set protocol in an ED chest pain unit, and evaluate whether serial ECG changes could be considered as prognostic factors. METHODS: Patients who met Agency for Health Care Policy and Research guidelines for intermediate risk for short-term cardiovascular event unstable angina were prospectively studied in the chest pain unit. Patients were monitored with the Mortara Instruments ELI 100 STM continuous 12-lead ECG system with ST-segment analysis. ST-segment changes of greater than 100 microV in 2 or more contiguous leads or greater than 200 microV in 1 lead were considered positive. Data were compared with serial serum cardiac markers, cardiac function study results, angiographic results, and 30-day outcome results. RESULTS: One hundred nineteen patients had serial ECG applied. The median duration of monitoring was 4.2 hours. Forty patients were given a diagnosis of acute coronary syndrome. Chest pain unit protocol detected 52 patients, and 23 were given a diagnosis of acute coronary syndrome (sensitivity 58%; specificity 63%). Sixteen patients had ST-segment changes of greater than 100 microV or greater than 200 microV, and 9 were given a diagnosis of acute coronary syndrome. The addition of the serial ECG to the chest pain unit protocol increased the sensitivity to 65% and decreased the specificity to 58%. Two patients with ST-segment changes but none without ST-segment changes had an adverse cardiac event, yielding a sensitivity of 100% and a specificity of 88%. CONCLUSION: Serial ECG is of limited value in the diagnostic evaluation of intermediate-risk patients managed in the chest pain unit with a standard protocol. However, when ST-segment changes are present, they indicate an increased likelihood for an adverse cardiac event.     

Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain.

OBJECTIVES: This study was designed to determine the diagnostic value of adenosine cardiac magnetic resonance (CMR) in troponin-negative patients with chest pain. BACKGROUND: We hypothesized that adenosine CMR could determine which troponin-negative patients with chest pain in an emergency department have coronary artery disease (CAD) or future adverse cardiac events. METHODS: Adenosine stress CMR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction (MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as coronary artery stenosis >50% on angiography, abnormal correlative stress test, new MI, or death. RESULTS: Adenosine perfusion abnormalities had 100% sensitivity and 93% specificity as the single most accurate component of the CMR examination. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis (log-rank test, p = 0.0006 and p < 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosine CMR was a more accurate predictor than cardiac risk factors (p < 0.002). CONCLUSIONS: In patients with chest pain who had MI excluded by troponin-I and non-diagnostic electrocardiograms, an adenosine CMR examination predicted with high sensitivity and specificity which patients had significant CAD during one-year follow-up. Furthermore, no patients with a normal adenosine CMR study had a subsequent diagnosis of CAD or an adverse outcome.     

Exercise echocardiographic detection of coronary artery disease in women

The utility of exercise echocardiography for the diagnosis of coronary artery disease has been demonstrated in populations consisting largely of men with a high prevalence of disease. To determine the diagnostic value of exercise echocardiography in women, 57 women who presented with chest pain were studied with coronary cineangiography and echocardiography combined with either treadmill (n = 38) or bicycle exercise (n = 19). Significant coronary artery disease (greater than or equal to 50% reduction in luminal diameter) was present in 28 (49%) of 57 patients, including 16 (84%) of 19 who had typical angina, and 12 (32%) of 38 who had atypical chest pain. The overall sensitivity and specificity of echocardiography were both 86%. Exercise echocardiography correctly determined the presence or absence of coronary artery disease in 32 (84%) of 38 patients who had atypical chest pain and in 17 (89%) of 19 who had typical angina (p = NS). The exercise electrocardiogram (ECG) was nondiagnostic in 17 patients (30%) who had rest ST segment depression or ST depression with exercise that could also be induced by hyperventilation or changes in position. The correct diagnosis was made by echocardiography in 14 (82%) of 17 patients with a nondiagnostic exercise ECG. In conclusion, exercise echocardiography has a clinically useful level of sensitivity and specificity for the detection of coronary artery disease in women. The technique provides diagnostic information in women presenting with atypical chest pain and in those who have a nondiagnostic exercise ECG.