Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study

Walker, Simon; Girardin, François; McKenna, Claire; Ball, Stephen G.; Nixon, John; Plein, Sven; Greenwood, John P; Sculpher, Mark

doi:10.1136/heartjnl-2013-303624

Cited by 95 publications

(82 citation statements)

References 24 publications

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“…Myocardial perfusion magnetic resonance imaging (MRI) is increasingly used as an accurate and reproducible technique for noninvasive diagnosis of coronary heart disease (CHD). Its potential advantages include a lack of ionizing radiation exposure, cost‐effectiveness, and additional information on cardiac anatomy, function, and tissue viability when performed as part of a multiparametric protocol 2, 3. Magnetic resonance (MR) perfusion imaging has high sensitivity and specificity as compared to x‐ray coronary angiography 4.…”

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confidence: 99%

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Kidambi

Sourbron

Maredia

et al. 2015

Magnetic Resonance Imaging

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PurposeTo examine factors associated with false‐negative cardiovascular magnetic resonance (MR) perfusion studies within the large prospective Clinical Evaluation of MR imaging in Coronary artery disease (CE‐MARC) study population. Myocardial perfusion MR has excellent diagnostic accuracy to detect coronary heart disease (CHD). However, causes of false‐negative MR perfusion studies are not well understood.Materials and MethodsCE‐MARC prospectively recruited patients with suspected CHD and mandated MR, myocardial perfusion scintigraphy, and invasive angiography. This subanalysis identified all patients with significant coronary stenosis by quantitative coronary angiography (QCA) and MR perfusion (1.5T, T 1‐weighted gradient echo), using the original blinded image read. We explored patient and imaging characteristics related to false‐negative or true‐positive MR perfusion results, with reference to QCA. Multivariate regression analysis assessed the likelihood of false‐negative MR perfusion according to four characteristics: poor image quality, triple‐vessel disease, inadequate hemodynamic response to adenosine, and Duke jeopardy score (angiographic myocardium‐at‐risk score).ResultsIn all, 265 (39%) patients had significant angiographic disease (mean age 62, 79% male). Thirty‐five (5%) had false‐negative and 230 (34%) true‐positive MR perfusion. Poor MR perfusion image quality, triple‐vessel disease, and inadequate hemodynamic response were similar between false‐negative and true‐positive groups (odds ratio, OR [95% confidence interval, CI]: 4.1 (0.82–21.0), P = 0.09; 1.2 (0.20–7.1), P = 0.85, and 1.6 (0.65–3.8), P = 0.31, respectively). Mean Duke jeopardy score was significantly lower in the false‐negative group (2.6 ± 1.7 vs. 5.4 ± 3.0, OR 0.34 (0.21–0.53), P < 0.0001).ConclusionFalse‐negative cardiovascular MR perfusion studies are uncommon, and more common in patients with lower angiographic myocardium‐at‐risk. In CE‐MARC, poor image quality, triple‐vessel disease, and inadequate hemodynamic response were not significantly associated with false‐negative MR perfusion. J. MAGN. RESON. IMAGING 2016;43:566–573.

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confidence: 99%

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Kidambi

Sourbron

Maredia

et al. 2015

Magnetic Resonance Imaging

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“…The recently published CE-MARC study established the superior diagnostic accuracy of cardiac MR over Singlephoton emission computed tomography (SPECT) and further cost-effectiveness analysis also proved its superiority as a diagnostic tool for ischemic heart disease [35].…”

Section: Perfusion Imaging-role Of Microvascular Obstructionmentioning

confidence: 99%

“…Recovery of function after revascularization appears to be related to the ratio of viable-to-scarred myocardium within dysfunctional myocardial segments. Different cutoff values for transmural extent of hyperenhancement have been applied to determine whether or not functional recovery post-revascularization can be expected, ranging from[0 % to [ 75 % [35]. Due to its superior spatial resolution, LGE by MRI is better than SPECT and Positron emission tomography (PET) at identifying regions of subendocardial scar [41].…”

Section: Cine Imagingmentioning

confidence: 99%

Novel MRI and CT Approaches for the Characterization of Myocardial Infarct

et al. 2013

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Accurate myocardial viability assessment is essential to optimize revascularization and/or medical treatment in patients with myocardial infarct. To date, cardiac magnetic resonance imaging (MRI) is the widely accepted clinical standard for visualization, characterization and quantification of myocardial viability. Multidetector computed tomography (CT) is reported by numerous authors as an emerging imaging modality for myocardial viability assessment. This review article summarizes cardiac MRI and CT modalities for myocardial viability assessment.

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“…35 Subanalysis of the original study indicated that cMRI is a cost-effective test and supported more widespread use of the modality. 36 Direct comparison to SPECT further benefits cMRI for its lack of ionizing radiation dose and higher spatial resolution. Increased sensitivity over SPECT has been shown in the IMPACT 1 study 32 especially for small, non-transmural or subendocardial infarcts.…”

Section: Cardiac Mr Perfusion Imagingmentioning

confidence: 99%

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

Bucher¹,

Cecco²,

Schoepf³

et al. 2014

BJR

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The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy firstpass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.

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Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study

Cited by 95 publications

References 24 publications

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Novel MRI and CT Approaches for the Characterization of Myocardial Infarct

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

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