腺苷负荷磁共振检查阴性对因胸痛到急诊科就诊的患者的预测价值

查看全文 作　　者：Ingkanisorn W.P.;Kwong R.Y.;Bohme N.S.;[1]A.E.Arai;田志 机构地区：[1]Laboratory of Cardiac Energetics,National Heart,Lung,and Blood Institute,National Institutes of Health,10 Center Drive,Bethesda,MD 20892-1061,United States.Dr 出　　处：《世界核心医学期刊文摘(心脏病学分册)》索引2006年第2卷第9期,共2页 摘　　要：OBJECTIVES: This study was designed to determine the diagnostic value of adeno sine cardiac magnetic resonance(CMR) in troponin-negative patients with chest p ain. BACKGROUND: We hypothesized that adenosine CMR could determine which tropon in-negative patients with chest pain in an emergency department have coronary a rtery disease(CAD) or future adverse cardiac events. METHODS: Adenosine stress C MR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction(MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as c oronary artery stenosis >50%on angiography, abnormal correlative stress test, n ew MI, or death. RESULTS: Adenosine perfusion abnormalities had 100%sensitivity and 93%specificity as the single most accurate component of the CMR examinatio n. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis( log-rank test, p=0.0006 and p< 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosin e CMR was a more accurate predictor than cardiac risk factors(p< 0.002). CONCLUS IONS: In patients with chest pain who had MI excluded by troponin-I and non-di agnostic electrocardiograms, an adenosine CMR examination predicted with high se nsitivity and specificity which patients had significant CAD during one-year fo llow-up. Furthermore, no patients with a normal adenosine CMR study had a subse quent diagnosis of CAD or an adverse outcome. 关 键 词：负荷试验异常 预测价值 急诊科 磁共振检查 腺苷 胸痛 阴性 就诊