Head to head comparison between perfusion and function during accelerated high-dose dipyridamole magnetic resonance stress for the detection of coronary artery disease

The aim of this study was to compare the diagnostic accuracy of perfusion and wall motion (WM) during dipyridamole magnetic resonance in patients with chest pain syndrome. Ninety-three patients with normal baseline left ventricular function were referred for coronary angiography. Additional dipyridamole stress magnetic resonance testing (0.84 mg/kg over 6 minutes; using a Signa Cvi scanner) was performed. Cardiac-gated fast gradient-echo train sequences with a first pass of gadolinium contrast medium were used to assess myocardial perfusion. A perfusion reserve index was calculated as the ratio of dipyridamole to rest upslope. A perfusion reserve index value 1.54 in 2 contiguous myocardial segments was the perfusion positivity criterion. The WM positivity criterion was a segmental score increase of or or =2 segments. WM and the perfusion reserve index showed similar diagnostic accuracy for 50% quantitatively assessed coronary diameter reduction (86% for both), with WM having higher specificity (96% vs 66%, p 0.01) and lower sensitivity (82% vs 93%, p 0.05) than the perfusion reserve index. Perfusion had the highest accuracy values for coronary stenoses 75% (cutoff 59%) and WM for coronary stenoses or