OBJECTIVES: This study was designed to determine the diagnostic value of adeno sine cardiac magnetic resonance(CMR) in troponin-negative patients with chest p ain. BACKGROUND: We hypothesized that adenosine CMR could ...OBJECTIVES: This study was designed to determine the diagnostic value of adeno sine cardiac magnetic resonance(CMR) in troponin-negative patients with chest p ain. BACKGROUND: We hypothesized that adenosine CMR could determine which tropon in-negative patients with chest pain in an emergency department have coronary a rtery disease(CAD) or future adverse cardiac events. METHODS: Adenosine stress C MR 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 c oronary artery stenosis >50%on angiography, abnormal correlative stress test, n ew MI, or death. RESULTS: Adenosine perfusion abnormalities had 100%sensitivity and 93%specificity as the single most accurate component of the CMR examinatio n. 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, adenosin e CMR was a more accurate predictor than cardiac risk factors(p< 0.002). CONCLUS IONS: In patients with chest pain who had MI excluded by troponin-I and non-di agnostic electrocardiograms, an adenosine CMR examination predicted with high se nsitivity and specificity which patients had significant CAD during one-year fo llow-up. Furthermore, no patients with a normal adenosine CMR study had a subse quent diagnosis of CAD or an adverse outcome.展开更多
目的:采用Meta分析评估腺苷负荷血氧水平依赖功能磁共振(BOLD-fMRI)对冠心病的诊断价值。方法:检索2000年1月-2016年8月国内外6个数据库(Pubmed、Cochrane图书馆、Embase、CNKI中国期刊全文数据库及外文生物医学文献数据库和万方数据知...目的:采用Meta分析评估腺苷负荷血氧水平依赖功能磁共振(BOLD-fMRI)对冠心病的诊断价值。方法:检索2000年1月-2016年8月国内外6个数据库(Pubmed、Cochrane图书馆、Embase、CNKI中国期刊全文数据库及外文生物医学文献数据库和万方数据知识资源系统)中关于腺苷负荷BOLD-fMRI诊断冠心病的中英文文献,分别使用Cochrane协作网QUADAS-1、Review Manager 5.3QUADAS-2对纳入文献进行质量评估,采用Meta-disc version 1.4软件进行Meta分析,获得BOLD-fMRI诊断冠心病的总体敏感度(SEN)、特异度(SPE)和诊断比值比(DOR),绘制工作特征曲线(ROC),计算曲线下面积(AUC)。结果:腺苷负荷BOLD-fMRI基于心肌节段(n=1738)水平诊断冠心病的总体SEN、SPE和DOR分别为0.79(95%CI:0.75~0.83)、0.73(95%CI:0.71~0.75)和11.79(95%CI:5.78~24.08),AUC为0.8504。结论:腺苷负荷BOLD-fMRI诊断冠心病的敏感性和特异性均较高,在临床上具有广阔的应用前景。展开更多
文摘OBJECTIVES: This study was designed to determine the diagnostic value of adeno sine cardiac magnetic resonance(CMR) in troponin-negative patients with chest p ain. BACKGROUND: We hypothesized that adenosine CMR could determine which tropon in-negative patients with chest pain in an emergency department have coronary a rtery disease(CAD) or future adverse cardiac events. METHODS: Adenosine stress C MR 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 c oronary artery stenosis >50%on angiography, abnormal correlative stress test, n ew MI, or death. RESULTS: Adenosine perfusion abnormalities had 100%sensitivity and 93%specificity as the single most accurate component of the CMR examinatio n. 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, adenosin e CMR was a more accurate predictor than cardiac risk factors(p< 0.002). CONCLUS IONS: In patients with chest pain who had MI excluded by troponin-I and non-di agnostic electrocardiograms, an adenosine CMR examination predicted with high se nsitivity and specificity which patients had significant CAD during one-year fo llow-up. Furthermore, no patients with a normal adenosine CMR study had a subse quent diagnosis of CAD or an adverse outcome.
文摘目的:采用Meta分析评估腺苷负荷血氧水平依赖功能磁共振(BOLD-fMRI)对冠心病的诊断价值。方法:检索2000年1月-2016年8月国内外6个数据库(Pubmed、Cochrane图书馆、Embase、CNKI中国期刊全文数据库及外文生物医学文献数据库和万方数据知识资源系统)中关于腺苷负荷BOLD-fMRI诊断冠心病的中英文文献,分别使用Cochrane协作网QUADAS-1、Review Manager 5.3QUADAS-2对纳入文献进行质量评估,采用Meta-disc version 1.4软件进行Meta分析,获得BOLD-fMRI诊断冠心病的总体敏感度(SEN)、特异度(SPE)和诊断比值比(DOR),绘制工作特征曲线(ROC),计算曲线下面积(AUC)。结果:腺苷负荷BOLD-fMRI基于心肌节段(n=1738)水平诊断冠心病的总体SEN、SPE和DOR分别为0.79(95%CI:0.75~0.83)、0.73(95%CI:0.71~0.75)和11.79(95%CI:5.78~24.08),AUC为0.8504。结论:腺苷负荷BOLD-fMRI诊断冠心病的敏感性和特异性均较高,在临床上具有广阔的应用前景。
