This study will assess the value of magnetic resonance imaging (MRI) in detecting heart
attack and heart attack risk in patients who come to the hospital emergency room because of
chest pain. It will also investigate whether MRI can help predict the coronary status of
patients 4 to 6 weeks and 1 year after emergency room admission.
Patients who come to the emergency room of Suburban Hospital in Bethesda, MD, because of
chest pain may be asked to enroll in this study if they have not been diagnosed as having a
heart attack. Participating patients will undergo a MRI scan as soon as emergency room
doctors determine they are in stable condition. For this procedure, the patient lies on a
table that slides into the MRI scanner-a large tubular machine with a magnetic field.
During the scan, a contrast material is injected into the vein. This material brightens the
image of the heart so that the blood flow can be seen. The scan will show if there are
areas of heart muscle that received insufficient blood flow. A second scan will be done
within 72 hours to look for coronary artery blockage that may require treatment. Patients
will be followed by telephone 4 to 8 weeks after the scans and again 1 year after the scans
to ask about any significant medical problems that may have occurred during those time
This study will provide information that may improve emergency treatment of patients with
acute chest pain by clarifying which patients require immediate medical treatment, which
should be admitted to the hospital for further evaluation, and which may safely be
discharged from the hospital.
Coronary artery disease remains the leading cause of death in the United States and results
in high diagnostic and therapeutic costs. The overall costs associated with the care of
patients with cardiovascular disease is projected to be $286.5 billion. Although MRI is a
relatively expensive technology, this methodology can provide all the noninvasive diagnostic
testing necessary to evaluate and triage patients with coronary artery disease. This "one
stop shop" has the potential to lower overall testing on this important patient population
and better delineate which patients require intervention. Beyond reproducing the results of
existing diagnostic tests, MRI has unique abilities to characterize myocardial tissue adding
information in the assessment of these patients that is not attainable by currently
available methodologies. This study will examine the hypothesis that MRI assessment of
regional LV function, resting myocardial perfusion, and myocardial tissue characteristics
can accurately detect a higher fraction of patients with acute myocardial infarction than is
possible with the ECG performed in the emergency department.
Ages above age 21 (children are excluded because myocardial infarction is so rare in this
population that the pre-test probability is comparable to the patients with less than 30
minutes of symptoms. Both of these groups have too small a fraction of true positive
events to benefit from testing with a sensitivity and specificity of approximately 0.85.
If initial results are better, we will reexamine the suitability of these tests for low
Capable of giving informed consent.
30 minutes of chest pain compatible with myocardial ischemia (chest pain score greater
Less than 270 pounds.
Patient states she may be pregnant (confirmed by urine or blood testing).
Severe congestive heart failure (unable to lie flat in bed).
Subjects on a mechanical ventilator.
Subjects with a cardiac pacemaker or implantable defibrillator.
Subjects with a cerebral aneurysm clip.
Subjects with a neural stimulator (e.g. TENS-Unit).
Subjects with any type of ear implant.
Subjects with metal in eye (e.g. from machining).
Subjects with implanted devices (e.g. insulin pump, drug infusion device).