Chronic Chest Pain-High Probability of CAD There is no relevant literature to support the use of MRI heart function and morphology without IV contrast in the initial evaluation of patients with chronic chest pain and a high probability of CAD with no known IHD. MRI Heart Function with Stress Without and With IV Contrast MRI with function/wall motion (dobutamine stress test) and MRI with vasodilator stress perfusion (adenosine/regadenoson stress test) have been used to diagnose hemodynamically significant CAD in patients with an intermediate to high likelihood of having significant stenosis. Investigations of MRI heart function stress for patients with known CAD indicate that patients with known (70%) or suspected (30%) CAD with inducible LV wall motion abnormalities during dobutamine CMR predict cardiac death and myocardial ischemia [46]. A single-center prospective study focusing on women with known or suspected CAD and variable clinical symptoms demonstrated that, similar to men, dobutamine CMR can identify cardiac risk in women with known or suspected IHD [47]. A single-center study of 815 consecutive patients referred for evaluation of suspected myocardial ischemia over a 10 year period has shown that stress CMR with its protocol including stress and rest myocardial perfusion, ventricular function, and late gadolinium enhancement, effectively reclassifies patient risk beyond standard clinical variables, specifically in patients at moderate to high pretest clinical risk and in patients with established CAD [48]. MRI heart function stress has a high NPV for adverse cardiac events in patients with known or suspected CAD [46,47].
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. Chronic Chest Pain-High Probability of CAD There is no relevant literature to support the use of MRI heart function and morphology without IV contrast in the initial evaluation of patients with chronic chest pain and a high probability of CAD with no known IHD. MRI Heart Function with Stress Without and With IV Contrast MRI with function/wall motion (dobutamine stress test) and MRI with vasodilator stress perfusion (adenosine/regadenoson stress test) have been used to diagnose hemodynamically significant CAD in patients with an intermediate to high likelihood of having significant stenosis. Investigations of MRI heart function stress for patients with known CAD indicate that patients with known (70%) or suspected (30%) CAD with inducible LV wall motion abnormalities during dobutamine CMR predict cardiac death and myocardial ischemia [46]. A single-center prospective study focusing on women with known or suspected CAD and variable clinical symptoms demonstrated that, similar to men, dobutamine CMR can identify cardiac risk in women with known or suspected IHD [47]. A single-center study of 815 consecutive patients referred for evaluation of suspected myocardial ischemia over a 10 year period has shown that stress CMR with its protocol including stress and rest myocardial perfusion, ventricular function, and late gadolinium enhancement, effectively reclassifies patient risk beyond standard clinical variables, specifically in patients at moderate to high pretest clinical risk and in patients with established CAD [48]. MRI heart function stress has a high NPV for adverse cardiac events in patients with known or suspected CAD [46,47].