Comparison of Cardiovascular Magnetic Resonance and Single-Photon Emission Computed Tomography in Women with Suspected Coronary Artery Disease from the CE-MARC Trial
Background—Coronary artery disease (CAD) is the leading cause of death in women and under-diagnosis contributes to their high mortality. This study compared the gender-specific diagnostic performance of cardiovascular magnetic resonance (CMR) and single-photon emission computed tomography (SPECT).
Methods and Results—235 females and 393 males with suspected angina underwent CMR, SPECT and X-ray angiography as part of the CE-MARC study. CMR comprised adenosine stress/rest perfusion, cine imaging, late gadolinium enhancement and MR coronary angiography. Gated adenosine stress/rest SPECT was performed using 99mTc-tetrofosmin. For CMR, the sensitivity in females and males was similar (88.7% vs. 85.6%, p=0.57), as was the specificity (83.5% vs. 82.8%, p=0.86). For SPECT, the sensitivity was significantly worse in females than males (50.9% vs. 70.8%, p=0.007), but specificities were similar (84.1% vs. 81.3%; p=0.48). Sensitivity in both female and male groups was significantly higher with CMR than SPECT (p<0.0001 for both) but specificity was similar (p=0.77 and 1.00 respectively). For perfusion-only components, CMR outperformed SPECT in females (area under curve [AUC]: 0.90 vs. 0.67, p<0.0001) and in males (AUC: 0.89 vs. 0.74, p<0.0001). Diagnostic accuracy was similar in both sexes with perfusion CMR (p=1.00), but significantly worse in females with SPECT (p<0.0001).
Conclusions—In both sexes, CMR has greater sensitivity than SPECT. Unlike SPECT, there are no significant gender differences in the diagnostic performance of CMR. These findings plus an absence of ionising radiation exposure, mean that CMR should be more widely adopted in women with suspected CAD.
Clinical Trial Registration Information—www.controlled-trials.com. Identifier: ISRCTN7724613
- cardiovascular magnetic resonance imaging
- single-photon emission computed tomography
- ischemic heart disease
- Received November 28, 2012.
- Revision received November 30, 2013.
- Accepted December 9, 2013.