Value of cardiovascular magnetic resonance stress perfusion testing for the detection of coronary artery disease in women

JACC Cardiovasc Imaging. 2008 Jul;1(4):436-45. doi: 10.1016/j.jcmg.2008.03.010.


Objectives: We wanted to assess the value of cardiovascular magnetic resonance (CMR) stress testing for evaluation of women with suspected coronary artery disease (CAD).

Background: A combined perfusion and infarction CMR examination can accurately diagnose CAD in the clinical setting in a mixed gender population.

Methods: We prospectively enrolled 147 consecutive women with chest pain or other symptoms suggestive of CAD at 2 centers (Duke University Medical Center, Robert-Bosch-Krankenhaus). Each patient underwent a comprehensive clinical evaluation, a CMR stress test consisting of cine rest function, adenosine-stress and rest perfusion, and delayed-enhancement CMR infarction imaging, and X-ray coronary angiography within 24 h. The components of the CMR test were analyzed visually both in isolation and combined using a pre-specified algorithm. Coronary artery disease was defined as stenosis > or =70% on quantitative analysis of coronary angiography.

Results: Cardiovascular magnetic resonance imaging was completed in 136 females (63.0 +/- 11.1 years), 37 (27%) women had CAD on coronary angiography. The combined CMR stress test had a sensitivity, specificity, and accuracy of 84%, 88%, and 87%, respectively, for the diagnosis of CAD. Diagnostic accuracy was high at both sites (Duke University Medical Center 82%, Robert-Bosch-Krankenhaus 90%; p = 0.18). The accuracy for the detection of CAD was reduced when intermediate grade stenoses were included (82% vs. 87%; p = 0.01 compared the cutoff of stenosis > or =50% vs. > or =70%). The sensitivity was lower in women with single-vessel disease (71% vs. 100%; p = 0.06 compared with multivessel disease) and small left ventricular mass (69% vs. 95%; p = 0.04 for left ventricular mass < or =97 g vs. >97 g). The latter difference was even more significant after accounting for end-diastolic volumes (70% vs. 100%; p = 0.02 for left ventricular mass indexed to end-diastolic volume < or =1.15 g/ml vs. >1.15 g/ml).

Conclusions: A multicomponent CMR stress test can accurately diagnose CAD in women. Detection of CAD in women with intermediate grade stenosis, single-vessel disease, and with small hearts is challenging.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenosine
  • Aged
  • Algorithms
  • Angina Pectoris / etiology*
  • Angina Pectoris / pathology
  • Angina Pectoris / physiopathology
  • Coronary Angiography
  • Coronary Circulation*
  • Coronary Stenosis / complications
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / physiopathology
  • Europe
  • Exercise Test
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted
  • Magnetic Resonance Imaging, Cine*
  • Middle Aged
  • Myocardial Perfusion Imaging / methods*
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sex Factors
  • Stroke Volume
  • United States
  • Women's Health*


  • Adenosine