Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Research Cardiology 2006;106:270–276 DOI: 10.1159/000093490 Non-Invasive Resting Magnetocardiographic Imaging for the Rapid Detection of Ischemia in Subjects Presenting with Chest Pain Kirsten Tolstrup a Bo E. Madsen b Jose A. Ruiz a Stephen D. Greenwood a Judeen Camacho a Robert J. Siegel a H. Caroline Gertzen b Jai-Wun Park c Peter A. Smars b a Cedars-Sinai Medical Center, Division of Cardiology, Los Angeles, Calif., and b Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minn., USA; c Klinikum Hoyerswerda, Division of Cardiology, Hoyerswerda, Germany tively, for the detection of ischemia (p ! 0.0001). Conclu- sions: MCG is a new rapid, non-invasive imaging tool able to detect repolarization abnormalities at rest consistent with ischemia in patients presenting with chest pain syn- drome and normal or non-specific 12-lead ECG and normal troponin. Copyright © 2006 S. Karger AG, Basel Introduction Ischemic heart disease is the leading single cause of death in the United States and a major health problem worldwide [1] . The direct cost of hospitalizations for isch- emic heart disease in the US alone is enormous and amounts to 1 15 billion USD. Consequently, it is very im- portant to facilitate more definitive ischemia evaluation, while avoiding unnecessary hospital admissions of non- cardiac chest pain patients as well as avoiding discharge of patients with myocardial infarction. For this purpose many centers have established chest pain units in the emergency department. The initial evaluation involves a 12-lead electrocardiogram (ECG) and cardiac markers Key Words Magnetocardiography  Ischemia  Unstable angina Abstract Background: Early diagnosis of ischemia is complicated by the poor sensitivity of standard tests and contraindication for stress testing in unstable angina patients. Magnetocardi- ography (MCG) imaging can be used for the rapid, non-inva- sive detection of ischemia at rest. Methods: We studied 125 patients with presumed ischemic chest pain. All were chest pain free at the time of scanning. A 6-minute resting MCG scan (CardioMag Imaging, Inc., New York, 9-channel system) was performed. Following the MCG scan, automated soft- ware data analysis was performed, and quantitative scores were automatically calculated for each subject. The pres- ence of ischemia was determined after testing with serial tro- ponins, stress testing, and/or coronary angiography. Re- sults: The mean age was 59.4 8 13.6 years. Most patients (86.4%) had non-ischemic 12-lead ECG and normal troponin (86.2%). Fifty-five patients (44.0%) were determined to be ischemic. The MCG sensitivity, specificity, positive and nega- tive predictive value was 76.4, 74.3, 70.0 and 80.0%, respec- Received: August 11, 2005 Accepted after revision: February 28, 2006 Published online: May 29, 2006 Kirsten Tolstrup, MD Cedars-Sinai Medical Center 8700 Beverly Blvd., Room 5624 Los Angeles, CA 90048 (USA) Tel. +1 310 423 4876, Fax +1 310 423 0245, E-Mail tolstrupk@cshs.org © 2006 S. Karger AG, Basel 0008–6312/06/1064–0270$23.50/0 Accessible online at: www.karger.com/crd