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The value of stress perfusion cardiovascular magnetic resonance imaging for patients referred from the adult congenital heart disease clinic: 5-year experience at the Toronto General Hospital

Published online by Cambridge University Press:  18 September 2013

Djeven P. Deva ,
Felipe S. Torres ,
Rachel M. Wald ,
S. Lucy Roche ,
Laura Jimenez-Juan ,
Erwin N. Oechslin  and
Andrew M. Crean
Djeven P. Deva
Affiliation:
Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada
Felipe S. Torres
Affiliation:
Radiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
Rachel M. Wald
Affiliation:
Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada
S. Lucy Roche
Affiliation:
Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada
Laura Jimenez-Juan
Affiliation:
Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Erwin N. Oechslin
Affiliation:
Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada
Andrew M. Crean*
Affiliation:
Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada
*
Correspondence to: Dr A. Crean, Division of Cardiology and Department of Medical Imaging, 1c-544 NCSB, Toronto General Hospital, 585, University Ave, Toronto, Canada M5G 2N2. Tel: +1 647 928 6616; Fax: +1 416-593-0502; E-mail: andrew.crean@uhn.ca
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Abstract

Background: Vasodilator stress perfusion cardiovascular magnetic resonance imaging is a clinically useful tool for detection of clinically significant myocardial ischaemia in adults. We report our 5-year retrospective experience with perfusion cardiovascular magnetic resonance in a large, quarternary adult congenital heart disease centre. Methods: We reviewed all cases of perfusion cardiovascular magnetic resonance in patients referred from the adult congenital heart disease service. Dipyridamole stress perfusion cardiovascular magnetic resonance was undertaken on commercially available 1.5 and 3 T cardiovascular magnetic resonance scanners. Late gadolinium enhancement imaging was performed 8–10 minutes after completion of the rest perfusion sequence. Navigator whole-heart coronary magnetic resonance angiography was also performed where feasible. Results of stress cardiovascular magnetic resonance were correlated with complementary imaging studies, surgery, and clinical outcomes. Results: Over 5 years, we performed 34 stress perfusion cardiovascular magnetic resonance examinations (11 positive). In all, 84% of patients had further investigations for ischaemia in addition to cardiovascular magnetic resonance. Within a subgroup of 19 patients who had definitive alternative assessment of their coronary arteries, stress perfusion cardiovascular magnetic resonance demonstrated a sensitivity of 82% and specificity of 100%. Of the 34 studies, two were false negatives, in which the aetiology of ischaemia was extrinsic arterial compression rather than intrinsic coronary luminal narrowing. Coronary abnormalities were identified in 71% of cases who had coronary magnetic resonance angiography. Conclusion: Stress perfusion cardiovascular magnetic resonance is a useful and accurate tool for investigation of myocardial ischaemia in an adult congenital heart disease population with suspected non-atherosclerotic coronary abnormalities.

Keywords

Heart defectscongenitalimagingmyocardial perfusionmagnetic resonance imagingartery diseasecoronarydipyridamoleadenosine
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 5 , October 2014 , pp. 822 - 830
Copyright
Copyright © Cambridge University Press 2013 

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