Adenosine stress first pass perfusion for the detection of coronary artery disease in patients with aortic stenosis:: a feasibility study

Purpose: Detection of coronary artery disease (CAD) with magnetic resonance imaging (MRI) using adenosine stress first pass perfusion in patients with aortic stenosis in comparison with invasive angiography. Twenty-three consecutive patients (15 male, mean age 68 +/- 12 years) with relevant aortic stenosis (aortic valve area 0.90 +/- 0.41 cm(2)) were examined by MRI (1.5 T, Philips Intera CV (TM)). Contrast-enhanced first pass perfusion was performed with adenosine stress (140 mu g/kg/min) and under rest conditions. The results were compared with invasive coronary angiography with regard to the presence of a relevant coronary artery stenosis (> 70%). Three of 23 patients (13%) had contraindications for adenosine administration (one patient with atrioventricular block, two patients with mild claustrophobia). In the remaining 20 patients, adenosine stress perfusion could be performed without any complications. CAD was correctly detected in eight patients and correctly ruled out in 10 of 12 patients. False-positive results were seen in two patients with severe myocardial hypertrophy. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 80%, 83%, and 100%, respectively. Adenosine stress perfusion can be performed without complications even in patients with high grade aortic stenosis. MRI is helpful to detect and rule out significant CAD in these patients. Severe myocardial hypertrophy may lead to false-positive results. Our initial results indicate that due to a high negative predictive value pre-operative invasive coronary angiography might probably be waived in patients without perfusion defects in stress MRI.