Key result
Multiparametric exercise stress cardiovascular magnetic resonance accurately diagnosed hemodynamically significant coronary artery disease with an area under the curve of 0.97.
Why the study?
The authors developed an in-scanner exercise stress CMR protocol and aimed to evaluate the diagnostic value of a multiparametric approach in suspected CAD compared with invasive FFR.
Does multiparametric exercise stress CMR accurately diagnose haemodynamically significant CAD compared to invasive FFR in patients with suspected CAD?
Observational (n=60)
Blinded (readers and interventionalists)
No
Does multiparametric exercise stress CMR accurately diagnose haemodynamically significant CAD compared to invasive FFR in patients with suspected CAD?
Effect estimate: AUC 0.97 (95% CI 0.94-1.00)
p-value: p=<0.001
Multiparametric exercise stress CMR provides excellent diagnostic accuracy for detecting hemodynamically significant CAD compared to invasive FFR.
Should not yet change CAD diagnostic pathways; hypothesis-generating for multiparametric exercise stress CMR pending larger validation.
Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94–1.00)] in discriminating between FFR-normal and FFR-positive patients. The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. Trial registration: ClinicalTrials.gov, NCT03217227, Registered 11 July 2017–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart
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Le et al. (2021) conducted an observational in Coronary artery disease (n=60). Multiparametric exercise stress cardiovascular magnetic resonance (ExCMR) vs. Clinical risk model was evaluated on Discrimination between FFR-normal and FFR-positive patients (diagnosis of hemodynamically significant CAD) (AUC 0.97, 95% CI 0.94-1.00, p=<0.001). Multiparametric exercise stress cardiovascular magnetic resonance accurately diagnosed hemodynamically significant coronary artery disease with an area under the curve of 0.97.
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