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Background: The purpose of the study was to determine the long-term prognostic value of normal adenosine stress cardiac magnetic resonance imaging (CMR) in patients referred for evaluation of myocardial ischemia., Methods: We reviewed 300 consecutive patients (age 65 ± 11 years, 74% male) with suspected or known coronary disease and normal wall motion who had undergone adenosine stress CMR negative for ischemia and scar. Most patients were at intermediate risk of coronary artery disease. The end points studied were all causes of mortality and major adverse cardiac events, including cardiac death, myocardial infarction, revascularization, and hospitalization for unstable angina., Results: During a mean follow-up of 5.5 years (mean = 5.4 ± 1.1), 16 patients died because of various causes (cardiac death in 5 patients). Three patients had a nonfatal myocardial infarction, 7 patients were hospitalized for revascularization, and 11 were medically treated for unstable angina. The annual cardiac event rate was 1.3% (0.78% in the first 3 years and 1.9% between the fourth and sixth years). The predictors of major adverse cardiac events in a multivariate analysis model were as follows: advanced age (hazard ratio [HR] 1.15, 95% confidence interval [95% CI] 1.02-1.30), diabetes (HR 17.5, 95% CI 2.2-140), and the habit of smoking (HR 5.9, 95% CI 1.0-35.5). For all causes of mortality, the only predictor was diabetes (HR 11.4, 95% CI 1.76-74.2). Patients with normal stress CMR had an excellent outcome during the 3 years after the study. The cardiac event rate was higher between the fourth and sixth years., Conclusion: Over a 5.5-year period, a low event rate and excellent prognosis occurred in patients with normal adenosine stress CMR. Low- to intermediate-risk patients with a normal CMR are at low risk for subsequent cardiac events., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Our purpose was to assess the value of second harmonic imaging compared with fundamental imaging for the diagnosis of coronary artery disease during dobutamine stress echocardiography., Patients and Methods: Sixty-four patients underwent dobutamine stress echocardiography with both fundamental imaging and second harmonic imaging. Coronary angiography was performed within 3 months. Ischemia was defined as new or worsening wall motion abnormalities in > or = 1 segment during dobutamine stress echocardiography. Coronary artery disease was defined as a > or = 70% luminal diameter stenosis in > or = 1 coronary artery by coronary angiography., Results: There was a higher prevalence of segments with invisible border with fundamental compared with second harmonic imaging both at rest (11% vs 8%, P < .05) and at peak stress (17% vs 10%, P < .001). Significant coronary artery disease was present in 49 (77%) patients. The sensitivity of dobutamine stress echocardiography for detection of coronary artery disease by fundamental and second harmonic imaging was, respectively, 78% and 94% (P < .05), whereas specificity was similar (73% vs 73%). Second harmonic imaging had a particularly higher sensitivity for the diagnosis of 1-vessel disease (93% vs 50%, P < .05)., Conclusion: The use of second harmonic imaging improves the sensitivity of dobutamine stress echocardiography for the diagnosis of coronary artery disease compared with fundamental imaging, particularly for 1-vessel coronary artery disease, whereas specificity remains unchanged.

Background: Recent experimental studies have shown that technetium 99m methoxyisobutyl isonitrile (MIBI) underestimates flow heterogeneity induced by dobutamine and that this might have an impact on the sensitivity of dobutamine MIBI in patients with single-vessel coronary artery disease (CAD). This study compares the accuracy of dobutamine MIBI single-photon emission computed tomography (SPECT) and simultaneous echocardiography in the diagnosis of single-vessel CAD., Methods and Results: Ninety-one patients (age 57 +/- 12 years) with single-vessel CAD or without significant CAD were studied with dobutamine (up to 40 microg/kg per minute)-atropine (up to 1 mg) stress echocardiography (DSE) and simultaneous MIBI SPECT imaging. CAD was predicted on the basis of myocardial ischemia (transient wall motion abnormalities by DSE and reversible perfusion defects by MIBI). Ischemia was detected by MIBI in 30 of the 54 patients with and in 10 of the 37 patients without significant single-vessel CAD (sensitivity 56%, confidence interval [CI] 45 to 66; specificity 73%, CI 64 to 82; accuracy 63%, CI 53 to 73). Ischemia was detected by DSE in 30 patients with and in 6 patients without significant CAD (sensitivity of DSE 56%, CI 45 to 66; specificity 84%, CI 76 to 91; accuracy 67%, CI 57 to 77, P = not significant vs MIBI). For both imaging methods, sensitivity was significantly higher in patients with left anterior descending than in patients with left circumflex or right coronary artery stenosis (75% vs 40%, P <.05). The addition of echocardiography to MIBI did not improve the diagnostic accuracy (68% CI 59 to 78, P = not significant vs DSE or MIBI alone)., Conclusions: DSE and MIBI SPECT imaging have similar moderate sensitivity for the diagnosis of single-vessel CAD. Sensitivity of each of these techniques is higher in patients with left anterior descending than in patients with left circumflex or right coronary artery stenosis. There is no improvement of diagnostic accuracy by use of the combination of both techniques.