ABSTRACT
PURPOSE: To examine the accuracy of magnetic resonance (MR) coronary angiography for the evaluation of coronary artery stenoses, and to compare the results with conventional angiography as the reference standard. MATERIALS AND METHODS: Eighteen patients were examined. The pulse sequence was an ECG-triggered, T2-prepared, fat-suppressed 3D true fast imaging with steady state precession sequence with navigator respiratory gating. No contrast material was used. The 3D slabs were oriented axially, covering the whole heart. The MR images were evaluated for the presence of stenoses exceeding 50% luminal narrowing. The diagnostic accuracy of MR angiography was calculated, and was compared with conventional coronary angiography. All patients gave informed consent, and the study was approved by the institutional ethics committee. RESULTS: In conventional angiography, 16 stenoses were detected in 11 patients, and 7 patients were normal. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MR coronary angiography for detecting coronary stenosis on segment-based analysis were 75%, 98%, 80%, 97%, and 96%, respectively. McNemar test demonstrated no significant difference between MR and conventional angiography (P = 0.62). CONCLUSION: MR coronary angiography is a non-invasive diagnostic method currently in a state of evolution. It has limitations, but can be regarded as an alternative noninvasive modality to detect coronary artery disease in selected patient in whom invasive angiography may be hazardous.
Subject(s)
Coronary Stenosis/diagnosis , Magnetic Resonance Angiography/methods , Magnetic Resonance Angiography/standards , Aged , Coronary Angiography/methods , Female , Humans , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
BACKGROUND: Although reciprocal ST segment depression (RSTD) in patients with acute inferior myocardial infarction is a common electrocardiogram finding, its significance is not yet established. In this prospective study, the relationship between RSTD and the extent of coronary artery disease (CAD) was investigated. PATIENTS AND METHODS: One hundred eighty-eight patients with acute inferior myocardial infarction who received thrombolytic therapy were enrolled in this study. The magnitude and location of ST segment depression in noninfarcted leads and the maximum ST segment elevation (STEmax) in inferior leads were measured. All patients were divided into two main groups according to the presence of RSTD and five subgroups according to the location of RSTD, the maximum RSTD and the STEmax. The coronary angiography was performed in all patients 28 +/- 4 days after acute myocardial infarction. RESULTS: There were no significant differences in the proportion of coronary disease risk factors in patients with, versus those without, RSTD (P=0.6). Multivessel CAD was present in 63 of the 108 (58%) patients with RSTD and in 32 of the 80 (40%) patients with no RSTD (P=0.02). According to the location of reciprocal changes, multivessel disease was present in significantly more patients with anterior RSTD concomitant with or without lateral ST segment depression (P=0.01 and P=0.03, respectively); the proportion of single vessel disease was greater in patients with only lateral RSTD (P=0.02). In addition, the presence of anterior RSTD to a greater magnitude than the STEmax in inferior myocardial infarction increases the likelihood of multivessel disease (P=0.006). CONCLUSIONS: The presence of RSTD during an acute inferior myocardial infarction correlates with the presence of multivessel CAD and may not be only an electrical phenomenon.
