Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial)

Journal of Cardiovascular Magnetic Resonance

Research

Juerg Schwitter¹  Nidal Al-Saadi²  Nadja Hoebel³  Thorsten Dill⁴  Stefan O Schönberg⁵  Ekkehart Sauer⁶  Tamas Simor⁷  Kalman Huettle⁸  Oliver Strohm⁹  Kurt Debl^1,10  Christian M Wacker^1,11  Norbert Wilke^1,12  Hakan Ahlstrom^1,13 

[1] Cardiology, University Hospital Lausanne, Rue de Bugnon 46, CH-1011, Lausanne, Switzerland;Franz-Volhard Clinic-Humboldt University, Berlin, Germany;GE Healthcare Buchler GmbH & Co.KG, Munich, Germany;Kerckhoff Clinics Bad Nauheim, Nauheim, Germany;Current affiliation - Sana Kliniken Duesseldorf, Duesseldorf, Germany;LMU Munich, Grosshadern, Germany;current affiliation - University Medical Center Mannheim, Mannheim, Germany;Landshut Hospital, Landshut, Germany;Medical University of Science, Pecs, Hungary;Semmelweis University Hospital, Budapest, Hungary;St. Gertrauden Hospital Berlin, Berlin, Germany;University Hospital Regensburg, Regensburg, Germany;University Hospital Wuerzburg, Wuerzburg, Germany;University of Florida Health Science Center, Gainesville/Jacksonville, USA;Uppsala University Hospital, Uppsala, Sweden;

关键词: Cardiovascular magnetic resonance;    Scintigraphy;    Coronary disease;    Perfusion;    Ischemia;   

DOI  :  10.1186/1532-429X-14-61

 received in 2012-05-25, accepted in 2012-08-09,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPerfusion-cardiovascular magnetic resonance (CMR) is generally accepted as an alternative to SPECT to assess myocardial ischemia non-invasively. However its performance vs gated-SPECT and in sub-populations is not fully established. The goal was to compare in a multicenter setting the diagnostic performance of perfusion-CMR and gated-SPECT for the detection of CAD in various populations using conventional x-ray coronary angiography (CXA) as the standard of reference.MethodsIn 33 centers (in US and Europe) 533 patients, eligible for CXA or SPECT, were enrolled in this multivendor trial. SPECT and CXA were performed within 4 weeks before or after CMR in all patients. Prevalence of CAD in the sample was 49% and 515 patients received MR contrast medium. Drop-out rates for CMR and SPECT were 5.6% and 3.7%, respectively (ns). The study was powered for the primary endpoint of non-inferiority of CMR vs SPECT for both, sensitivity and specificity for the detection of CAD (using a single-threshold reading), the results for the primary endpoint were reported elsewhere. In this article secondary endpoints are presented, i.e. the diagnostic performance of CMR versus SPECT in subpopulations such as multi-vessel disease (MVD), in men, in women, and in patients without prior myocardial infarction (MI). For diagnostic performance assessment the area under the receiver-operator-characteristics-curve (AUC) was calculated. Readers were blinded versus clinical data, CXA, and imaging results.ResultsThe diagnostic performance (= area under ROC = AUC) of CMR was superior to SPECT (p = 0.0004, n = 425) and to gated-SPECT (p = 0.018, n = 253). CMR performed better than SPECT in MVD (p = 0.003 vs all SPECT, p = 0.04 vs gated-SPECT), in men (p = 0.004, n = 313) and in women (p = 0.03, n = 112) as well as in the non-infarct patients (p = 0.005, n = 186 in 1–3 vessel disease and p = 0.015, n = 140 in MVD).ConclusionIn this large multicenter, multivendor study the diagnostic performance of perfusion-CMR to detect CAD was superior to perfusion SPECT in the entire population and in sub-groups. Perfusion-CMR can be recommended as an alternative for SPECT imaging.Trial registrationClinicalTrials.gov, Identifier: NCT00977093

【 授权许可】

CC BY   
© Schwitter et al.; licensee BioMed Central Ltd. 2012