Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis

Abstract

Background: Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR. Methods: Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (Rev-Man) 5.3 and Stata software. Results: A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on the FFR thresholds, higher sensitivity and specificity (both 90%) were noted with the higher cutoff (0.75) and lower cutoff (0.8), respectively. At the vessel level, sensitivity and specificity at the lower FFR threshold were significantly higher at 88% and 89%, compared to the corresponding values for higher cutoff at 0.75. Similarly, meta-regression analysis of SCMR at higher (3T) resolution showed a higher sensitivity of 87% at the patient level and higher specificity of 90% at the vessel level. The highest sensitivity and specificity of SCMR (92% and 94%, respectively) were noted in studies with CAD prevalence greater than 60%. Conclusions: SCMR has high diagnostic accuracy for CAD comparable to FFR at a spatial resolution of 3T and an FFR cutoff of 0.80. An increase in CAD prevalence further improved the specificity of SCMR.

Practice recommendations for physiotherapists in Canada managing adverse events associated with acupuncture

“…Therefore, to reduce the risk of infection, use of the smallest number of needle insertions for the shortest time is recommended. 15,16 In particular, the use of indwelling needles is considered by some to be contraindicated in patients with valvular heart disease.…”

Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis

“…CA and FFR are commonly regarded as the reference standard for the detection and evaluation of prognosis of CAD. However, they are an invasive approach and have potential risks for human body (28,39). In contrast, non-invasive techniques such as CMR, SPECT, and PET embraced higher spatial resolution and low dose of radiation (CMR is free of nuclear radiation); they are undergoing an increase in clinical utility despite the relatively high cost (12,40,41).…”

“…To our knowledge, accumulated studies and meta-analysis have evaluated diagnostic performance of both invasive and noninvasive approaches for the confirmation of CAD (28)(29)(30)(31)(32)(33)(34). The aim of this meta-analysis was to generate a more comprehensive comparison of CMR, SPECT, and PET in the detection of CAD by collating the available evidence and subsequently to provide meaningful and hints for not only the field of implement research but also for the implementation and decision-making in clinical settings.…”

Efficiency assessment of a two-stage diagnostic strategy combining CT angiography and fractional flow reserve derived from coronary CT angiography for the detection of myocardial ischemia: a simulation study

“…In the initial selection, we extracted eight, nine, six, four, one, two, and three articles on CCTA, FFRCT, CMRI, SPECT, PET, SE, and CTP, respectively (Table S4). To select articles for the analysis, three articles for each modality were extracted [23][24][25][26][27][28][29][30][31][32]. Among them, the articles by Celeng 1.…”