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

Phase

N/A

Condition

Chest Pain

Myocardial Ischemia

Hypercholesterolemia

Treatment

N/A

Clinical Study ID

NCT00929227

090164

09-H-0164

Ages 18-100
All Genders

Study Summary

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.

Eligibility Criteria

Inclusion

GENERAL INCLUSION CRITERIA:
18 years of age and older
Prior equivocal stress study within the preceding 90 days
Able to provide informed consent

Exclusion

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 afterreceiving gadolinium)
Second (Type II) and third degree atrioventricular heart block
Asthma or chronic pulmonary disease (emphysema) actively treated with bronchodilatorsor 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

Study Design

July 01, 2009

November 19, 2020

Study Description

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.

Connect with a study center

National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland 20892
United States
Site Not Available
Suburban Hospital
Bethesda, Maryland 20814
United States
Site Not Available

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