Abstract 21797: Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (The CE-MARC Study): A Prospective Evaluation of 750 Patients
Background: Multi-component cardiovascular magnetic resonance (CMR) has been proposed for the diagnosis of coronary heart disease (CHD), but diagnostic accuracy has only been assessed in small scale studies and selected populations.
Methods: CE-MARC is a prospective pragmatic cohort study of 750pts presenting with stable chest pain and at least 1 cardiovascular risk factor. Recruited patients were scheduled for CMR and SPECT (order randomised) followed in all patients by invasive coronary angiography. The CMR protocol comprised rest and adenosine stress perfusion, cine imaging, late gadolinium enhancement and MR coronary angiography. Gated stress (adenosine)/rest SPECT was performed using 99mTc tetrofosmin (Myoview). Analysis was performed on a per patient basis using a 17-segment model. A sample size of 750pts allowed estimation of the sensitivity and specificity of CMR's diagnostic accuracy against X-ray angiography to within +/−3.5%.
Results: 752pts (mean age 60yrs, 62% male) were randomised. Prevalence of significant CHD was 39% (1VD 21%; 2VD 12%; 3VD 6%). The sensitivity of a multi-parametric CMR study was 86.1% (95%CI: 81.4-89.7), specificity 82.9% (95%CI: 79.0-86.3), PPV 76.6% (95%CI: 71.5-81.0) and NPV 90.2% (95%CI: 86.8-92.8). For the secondary analysis the sensitivity of SPECT was 66.5% (95%CI: 60.4-72.1), specificity 82.6% (95%CI: 78.5-86.1), PPV 71.4% (95%CI: 65.3-76.9) and NPV 79.1% (95%CI: 74.8-82.8). The difference between the sensitivities of CMR and SPECT was statistically significant (McNemar's Chi-Squared Test; χ2=31.18, 1df. P<0.001), but for the specificities was not (χ2=0.04, 1df. P=0.916). The differences between the predictive values of the tests were also statistically significant (PPV χ2=3.87, 1df. P=0.05; NPV χ2=32.96, 1df. P<0.001).
Conclusions: CE-MARC is the largest, prospective evaluation of CMR in unselected patients with stable chest pain and establishes the diagnostic accuracy of
- © 2010 by American Heart Association, Inc.