Comparison of Cardiac Computed Tomography and Vasodilator Stress Magnetic Resonance Imaging Perfusion in Patients With Prior Equivocal Stress Test for Detection of Coronary Artery Disease
| Status: | Suspended |
|---|---|
| Conditions: | Angina, Peripheral Vascular Disease, Cardiology, Psychiatric |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 100 |
| Updated: | 4/6/2019 |
| Start Date: | June 24, 2009 |
Background:
- Noninvasive cardiac stress testing is imperfect. Inconclusive test results generate
further expensive testing.
- In patients with known or suspected coronary artery disease, both computed tomography
(CT) and magnetic resonance imaging (MRI) have been shown to provide suitable results
for detecting the disease. However, both types of scans have limitations in their
usefulness, and it is not known whether one is preferable in either accuracy or
cost-effectiveness.
Objectives:
- To determine the accuracy and cost-effectiveness of CT and MRI in subjects with a prior
inconclusive heart stress test.
Eligibility:
- Patients 18 years of age and older who have had an inconclusive heart stress test within
the past 90 days.
Design:
- A blood test will be obtained prior to both heart tests. This will require less than a
teaspoon of blood.
- A CT scan will be performed, accompanied by beta blocker medications (to slow heart
rate) or nitroglycerin (to enlarge blood vessels) to improve picture quality, as needed.
- An MRI scan will be performed. Scans will be taken before, during, and after the patient
receives vasodilators (to increase blood flow to the coronary arteries and detect
blockages in heart blood vessels).
- Heart rate and function will be monitored with an electrocardiogram.
- Noninvasive cardiac stress testing is imperfect. Inconclusive test results generate
further expensive testing.
- In patients with known or suspected coronary artery disease, both computed tomography
(CT) and magnetic resonance imaging (MRI) have been shown to provide suitable results
for detecting the disease. However, both types of scans have limitations in their
usefulness, and it is not known whether one is preferable in either accuracy or
cost-effectiveness.
Objectives:
- To determine the accuracy and cost-effectiveness of CT and MRI in subjects with a prior
inconclusive heart stress test.
Eligibility:
- Patients 18 years of age and older who have had an inconclusive heart stress test within
the past 90 days.
Design:
- A blood test will be obtained prior to both heart tests. This will require less than a
teaspoon of blood.
- A CT scan will be performed, accompanied by beta blocker medications (to slow heart
rate) or nitroglycerin (to enlarge blood vessels) to improve picture quality, as needed.
- An MRI scan will be performed. Scans will be taken before, during, and after the patient
receives vasodilators (to increase blood flow to the coronary arteries and detect
blockages in heart blood vessels).
- Heart rate and function will be monitored with an electrocardiogram.
Noninvasive cardiac stress testing is imperfect. Inconclusive test results generate further
expensive testing. We will do both cardiac computed tomography (CT) and stress cardiac
magnetic resonance imaging (MRI) in patients who have an inconclusive noninvasive cardiac
stress test. We will test whether MRI predicts significant coronary artery disease in a more
cost effective and accurate manner than CT, or vice versa.
expensive testing. We will do both cardiac computed tomography (CT) and stress cardiac
magnetic resonance imaging (MRI) in patients who have an inconclusive noninvasive cardiac
stress test. We will test whether MRI predicts significant coronary artery disease in a more
cost effective and accurate manner than CT, or vice versa.
- GENERAL INCLUSION CRITERIA:
- 18 years of age and older
- Prior equivocal stress study within the preceding 90 days
- Able to provide informed consent
MEDICAL EXCLUSION CRITERIA:
- Decompensated heart failure (unable to lie flat during MRI or CT)
- Severe kidney disease (MDRD estimated Glomerular Filtration Rate less than
30mL/min/1.73m(2).
- Prior cardiac revascularization with coronary stent or bypass surgery
- Resting tachycardia (HR greater than l00 bpm)
- Pregnant women (when uncertain, subjects will undergo urine or blood testing)
- Lactating women (unless they are willing to discard breast milk for 24 hours after
receiving gadolinium)
- Second (Type II) and third degree atrioventricular heart block
- Asthma or chronic pulmonary disease (emphysema) actively treated with bronchodilators
or leukotriene antagonists
MRI EXCLUSION CRITERIA:
- Cardiac pacemaker or implantable defibrillator
- Cerebral aneurysm clip
- Neural stimulator (e.g. TENS-Unit)
- Any type of ear implant
- Ocular foreign body (e.g. metal shavings)
- Any implanted device (e.g. insulin pump, drug infusion device)
- Metal shrapnel or bullet
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Suburban Hospital Suburban Hospital is a community-based, not-for-profit hospital serving Montgomery County and the surrounding...
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9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
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