Is the diagnostic yield of myocardial stress perfusion MRI impaired by three-vessel coronary artery disease?

Klumpp, Bernhard; Miller, Stephan; Seeger, Achim; May, Andreas E.; Gawaz, Meinrad; Claussen, Claus D.; Krämer, Ulrich

doi:10.1177/0284185114523758

Cited by 3 publications

(8 citation statements)

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“…The overall quality of included studies was high (eFigure 2 and eTable 3 in Supplement 1). The main characteristics of studies included in the diagnostic and prognostic meta-analyses are summarized in eTables 1 and 2 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“…The diagnostic accuracy of stress CMR compared with ICA as the reference test was reported in 30 studies pooling 7496 symptomatic patients, of whom 537 had known CAD and 2825 had suspected CAD. In the per-patient analysis, stress CMR yielded a pooled DOR of 19.1 (95% CI, 12.6-29.1), a sensitivity of 84% (95% CI, 79%-88%), a specificity of 79% (95% CI, 73%-84%), a PLR of 4.0 (95% CI, 3.0-5.3), an NLR of 0.2 (95% CI, 0.2-0.3), and an AUROC of 0.81 (95% CI, 0.78-0.84) for the detection of anatomically obstructive CAD (Figure 1A).…”

Section: Resultsmentioning

confidence: 99%

“…According to the QUADAS-2 tool, risk of bias was low in 29 of 33 diagnostic studies (eFigure 2 in Supplement 1). Of 31 prognostic studies, 15 studies scored 9 stars and 16 studies scored 8 stars according to the Newcastle-Ottawa Scale (eTable 3 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…Of 31 prognostic studies, 15 studies scored 9 stars and 16 studies scored 8 stars according to the Newcastle-Ottawa Scale (eTable 3 in Supplement 1). In ICA studies, the Deeks test ruled out small study bias and publication bias ( P = .34) (eFigure 3 in Supplement 1). The Deeks test was not performed in FFR studies because the number of studies was insufficient.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

et al. 2023

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ImportanceThe clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown.ObjectiveTo provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain.Data SourcesPubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021.Study SelectionSelected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included.Data Extraction and SynthesisThis systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Main Outcomes and MeasuresDiagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death.ResultsA total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%.Conclusion and RelevanceIn this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

et al. 2023

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“…We divided them into 2 subgroups (0.20-0.30 and 0.30-0.50 mCi/kg) for analysis and comparison. Third were the factors affecting hemodynamic status, including LM stenosis and the number of stenotic coronary arteries (45)(46)(47). For the former, we divided LM into stenosis and non-stenosis subgroups with >50% as the threshold, and the latter was divided into 2 subgroups: 0-1 vessel stenoses and 2-3 vessels stenoses.…”

Section: Discussionmentioning

confidence: 99%

Development and evaluation of a radiomics model of resting 13N-ammonia positron emission tomography myocardial perfusion imaging to predict coronary artery stenosis in patients with suspected coronary heart disease

Zhang¹,

Sun²,

Liu³

et al. 2022

Ann Transl Med

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Background: Coronary angiography (CAG) is usually performed in patients with coronary heart disease (CHD) to evaluate the coronary artery stenosis. However, patients with iodine allergy and renal dysfunction are not suitable for CAG. We try to develop a radiomics machine learning model based on rest 13 N-ammonia ( 13 N-NH 3 ) positron emission tomography (PET) myocardial perfusion imaging (MPI) to predict coronary stenosis.Methods: Eighty-four patients were included with the inclusion criteria: adult patients; suspected CHD; resting MPI and CAG were performed; and complete data. Coronary artery stenosis >75% were considered to be significant stenosis. Patients were randomly divided into a training group and a testing group with a ratio of 1:1. Myocardial blood flow (MBF), perfusion defect extent (EXT), total perfusion deficit (TPD), and summed rest score (SRS) were obtained. Myocardial static images of the left ventricular (LV) coronary segments were segmented, and radiomics features were extracted. In the training set, the conventional parameter (MPI model) and radiomics (Rad model) models were constructed using the machine learning method and were combined to construct a nomogram. The models' performance was evaluated by AUC, accuracy, sensitivity, specificity, decision analysis curve (DCA), and calibration curves. Testing and subgroup analysis were performed.Results: MPI model was composed of MBF and EXT, and Rad model was composed of 12 radiomics features. In the training set, the AUC/accuracy/sensitivity/specificity of the MPI model, Rad model, and

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Cardiac Computed Tomography and Magnetic Resonance Imaging

Mittal

2020

Cardiac Surgery

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Is the diagnostic yield of myocardial stress perfusion MRI impaired by three-vessel coronary artery disease?

Cited by 3 publications

References 29 publications

Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

Development and evaluation of a radiomics model of resting 13N-ammonia positron emission tomography myocardial perfusion imaging to predict coronary artery stenosis in patients with suspected coronary heart disease

Cardiac Computed Tomography and Magnetic Resonance Imaging

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