In symptomatic patients with an intermediate or high pretest probability for disease, noncontrast coronary MRA had a patient-based sensitivity of 96%, a specificity of 68%, a PPV of 79%, and an 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. Extrapolation of data on MRI heart function and morphology without and with IV contrast for patients with known CAD is provided below, with a note that no information is available regarding the presence or absence of chest pain in patients included in these studies [70,90-98]. In a multicenter study, assessment of a consecutive 1,560 patients with established or suspected CAD has shown that both LVEF and the amount of myocardial damage are independent predictors of all-cause mortality. Even in patients with near-normal LVEF, significant infarction identifies a cohort with a high risk for early mortality [70]. Demonstration of residual contractile function in dysfunctional segments in response to dobutamine stimulation at cine MRI has been shown to be better than delayed-enhancement MRI alone for prediction of recovery of segmental function 3 months after revascularization [98]. Late gadolinium enhancement MRI can demonstrate the presence, location, and transmural extent of acute and chronic myocardial infarctions [90,95], with a sensitivity of 99% for the detection of acute infarction and 94% for the detection of chronic infarction [95].
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%, a specificity of 68%, a PPV of 79%, and an 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. Extrapolation of data on MRI heart function and morphology without and with IV contrast for patients with known CAD is provided below, with a note that no information is available regarding the presence or absence of chest pain in patients included in these studies [70,90-98]. In a multicenter study, assessment of a consecutive 1,560 patients with established or suspected CAD has shown that both LVEF and the amount of myocardial damage are independent predictors of all-cause mortality. Even in patients with near-normal LVEF, significant infarction identifies a cohort with a high risk for early mortality [70]. Demonstration of residual contractile function in dysfunctional segments in response to dobutamine stimulation at cine MRI has been shown to be better than delayed-enhancement MRI alone for prediction of recovery of segmental function 3 months after revascularization [98]. Late gadolinium enhancement MRI can demonstrate the presence, location, and transmural extent of acute and chronic myocardial infarctions [90,95], with a sensitivity of 99% for the detection of acute infarction and 94% for the detection of chronic infarction [95].