Moderated Poster Presentations 201. A Combined Single-Session Analysis of Adenosine Perfusion and of High-Dose Dobutamine Stress Cardiovascular Magnetic Resonance Improves Diagnosis of Ischemia

Introduction: With CMR, both the analysis of myocardial perfusion during adenosine stress (Perfusion-CMR) and of wall motion during dobutamine stress (StressCMR) were shown highly accurate for the diagnosis of myocardial ischemia. A combined single session dual stress protocol has not been reported so far. Purpose: To compare the diagnostic accuracy of perfusion-CMR and stress-CMR in an unselected patient population, and to determine whether a combined single-session assessment of myocardial perfusion and wall motion improves diagnosis of ischemia, with invasive quantitative coronary angiography serving as reference standard. Methods: 100 consecutive patients with signs or symptoms of coronary artery disease (mean age 62±9 years; prior myocardial infarction: 30%; prior PTCA: 48% and CABG: 27%) were examined (1.5 T ACS NT Philips) prior to clinically indicated invasive coronary angiography. Myocardial perfusion was visually assessed during the first pass of a contrast agent bolus from 60 dynamics (3 short axis images acquired every heartbeat; TFE-EPI hybrid sequence; pp-delay 200 ms; TR/TE/flip 3.6/12/30) during adenosine infusion (140 ug.kg .min ) and at rest. Stress-CMR images were acquired at rest and during a standardized high-dose dobutamine-atropine protocol in 3 short-axis (same 3 short-axis views as for perfusion-CMR), a 4-, a 3and a 2-chamber view (single slice steady state free precession technique; TR/TE/flip 3.0/1.5/55). Regional wall motion was assessed using a multiple screen format, a 16 segment model, and a 4-point scoring system. A new or worsening wall motion abnormality in 1 segment was considered positive for ischemia. In the absence of ischemia, failure to attain 85% of age-predicted maximal heart rate was defined as a non-diagnostic result. Results: Significant coronary artery disease ( 50% diameter stenoses by quantitative invasive coronary angiography) was found in 69% of patients. No significant adverse effects occurred during stress testing. Sensitivity, specificity and diagnostic accuracy of stress-CMR were 87%, 84% and 86%, respectively, with one non-diagnostic test (1%; target heart rate not