In symptomatic patients with an intermediate or high pretest probability for disease, noncontrast coronary MRA had a patient-based sensitivity of 96%, specificity of 68%, PPV of 79%, and NPV of 93% in the detection of functionally significant CAD as defined by a >90% stenosis or FFR <0.8 on catheter angiography. When added to a comprehensive stress-rest MRI protocol, it had a nonsignificant increase in diagnostic accuracy [42]. MRI Heart Function and Morphology Without and With IV Contrast MRI heart function and morphology without and with IV contrast can demonstrate myocardial infarction and ischemia secondary to CAD and can provide assessment of LV wall function. Areas of myocardial infarction detected on MRI have been shown to be a predictor of mortality and major adverse cardiac events, compared with clinical data, coronary sclerosis at angiography, or LV end-systolic volume index (ESVI) and LV ejection fraction (LVEF) in patients with suspected CAD, even when areas of infarction are small. Even a small area of infarction (<2% of LV mass) was associated with a greater than 7-fold increase in risk for a major adverse cardiac event. Delayed-enhancement MRI in patients without known CAD is associated with lower LVEF and greater LV mass [43]. A single-center observational prospective study with 376 patients with a history suggesting stable CAD but with no history of myocardial ischemia demonstrated that evidence of myocardial infarction on CMR is an independent noninvasive marker of prognosis in stable CAD patients [44] and remains the strongest predictor of adverse events, even after adjustment for significant CAD on angiogram, LVEF, and wall motion abnormality [44,45]. MRI Heart Function and Morphology Without IV Contrast MRI heart function and morphology without IV contrast provides assessment of ejection fraction and ventricular volumes including LVEF and ESVI with a higher sensitivity to detect prior myocardial infarct than ischemia.
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. In symptomatic patients with an intermediate or high pretest probability for disease, noncontrast coronary MRA had a patient-based sensitivity of 96%, specificity of 68%, PPV of 79%, and NPV of 93% in the detection of functionally significant CAD as defined by a >90% stenosis or FFR <0.8 on catheter angiography. When added to a comprehensive stress-rest MRI protocol, it had a nonsignificant increase in diagnostic accuracy [42]. MRI Heart Function and Morphology Without and With IV Contrast MRI heart function and morphology without and with IV contrast can demonstrate myocardial infarction and ischemia secondary to CAD and can provide assessment of LV wall function. Areas of myocardial infarction detected on MRI have been shown to be a predictor of mortality and major adverse cardiac events, compared with clinical data, coronary sclerosis at angiography, or LV end-systolic volume index (ESVI) and LV ejection fraction (LVEF) in patients with suspected CAD, even when areas of infarction are small. Even a small area of infarction (<2% of LV mass) was associated with a greater than 7-fold increase in risk for a major adverse cardiac event. Delayed-enhancement MRI in patients without known CAD is associated with lower LVEF and greater LV mass [43]. A single-center observational prospective study with 376 patients with a history suggesting stable CAD but with no history of myocardial ischemia demonstrated that evidence of myocardial infarction on CMR is an independent noninvasive marker of prognosis in stable CAD patients [44] and remains the strongest predictor of adverse events, even after adjustment for significant CAD on angiogram, LVEF, and wall motion abnormality [44,45]. MRI Heart Function and Morphology Without IV Contrast MRI heart function and morphology without IV contrast provides assessment of ejection fraction and ventricular volumes including LVEF and ESVI with a higher sensitivity to detect prior myocardial infarct than ischemia.