European heart journal. Cardiovascular Imaging · 2026
Accelerated stress CMR for the detection of significant coronary artery disease: a prospective randomized diagnostic accuracy study.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Elshibly Mohamed, Shergill Simran, Velvet Anju, Gohar Aisha, Pattani Shreyansh, Parke Kelly S, England Rachel, Moafi Aida, Hudson George, Khoo Jeffrey, O'Regan Declan P, Wu Olivia, Adlam David, Kellman Peter, McIntosh Alasdair, McConnachie Alex, Ladwiniec Andrew, McCann Gerry P, Arnold J Ranjit
Аннотация
AIMS: In patients with suspected coronary artery disease (CAD), the role of adenosine-stress cardiovascular magnetic resonance (CMR) is well established. However, to meet increasing demand, improving its time efficiency and cost-effectiveness is critical. Recent advances in accelerated, free-breathing cine and scar imaging now enable accelerated stress-perfusion protocols. This study evaluated whether an accelerated, stress-only perfusion protocol achieves non-inferior diagnostic accuracy compared with a standard stress-rest perfusion CMR protocol for detecting significant CAD.
METHODS AND RESULTS: Patients with suspected angina referred for invasive coronary angiography (ICA) underwent two 3-Tesla CMR scans (standard and accelerated protocols), on separate days in randomized order. Significant CAD was defined as fractional flow reserve (FFR) ≤ 0.80 in epicardial vessels ≥2 mm diameter (or quantitative flow ratio ≤0.80 if FFR unavailable). CMR images were evaluated qualitatively with (i) primary per-vessel analysis (determined by two independent readers) and (ii) secondary per-patient analysis (following consensus read). Of 167 prospectively recruited patients, 150 completed both CMR protocols and ICA (mean age 66 ± 10 years, 71% male, CAD prevalence 51%). The accelerated scan was better tolerated by patients, with scan duration 19 ± 5 min (24 min shorter than the standard protocol [95% CI: 23, 25], P < 0.001). Compared with standard CMR, accelerated CMR achieved non-inferior per-vessel diagnostic accuracy at a pre-specified 5% non-inferiority margin (+0.7% [-2.7%, 4.0%], pnon-inferiority = 0.001 and +3.4% [-0.1%, 6.8%], pnon-inferiority < 0.001 for the two readers). Accelerated CMR also achieved comparable per-patient accuracy (+4.6% [-1.5%, 11.0%], P = 0.189 for consensus read; accuracy 88.6%, sensitivity 84.2%, and specificity 93.2%).
CONCLUSION: Compared to standard stress-perfusion CMR, an accelerated stress-perfusion protocol achieves non-inferior diagnostic accuracy at the vessel level, with a time saving of over 20 min per scan. Accelerated imaging may prove effective in the clinical arena to evaluate patients with suspected angina.
METHODS AND RESULTS: Patients with suspected angina referred for invasive coronary angiography (ICA) underwent two 3-Tesla CMR scans (standard and accelerated protocols), on separate days in randomized order. Significant CAD was defined as fractional flow reserve (FFR) ≤ 0.80 in epicardial vessels ≥2 mm diameter (or quantitative flow ratio ≤0.80 if FFR unavailable). CMR images were evaluated qualitatively with (i) primary per-vessel analysis (determined by two independent readers) and (ii) secondary per-patient analysis (following consensus read). Of 167 prospectively recruited patients, 150 completed both CMR protocols and ICA (mean age 66 ± 10 years, 71% male, CAD prevalence 51%). The accelerated scan was better tolerated by patients, with scan duration 19 ± 5 min (24 min shorter than the standard protocol [95% CI: 23, 25], P < 0.001). Compared with standard CMR, accelerated CMR achieved non-inferior per-vessel diagnostic accuracy at a pre-specified 5% non-inferiority margin (+0.7% [-2.7%, 4.0%], pnon-inferiority = 0.001 and +3.4% [-0.1%, 6.8%], pnon-inferiority < 0.001 for the two readers). Accelerated CMR also achieved comparable per-patient accuracy (+4.6% [-1.5%, 11.0%], P = 0.189 for consensus read; accuracy 88.6%, sensitivity 84.2%, and specificity 93.2%).
CONCLUSION: Compared to standard stress-perfusion CMR, an accelerated stress-perfusion protocol achieves non-inferior diagnostic accuracy at the vessel level, with a time saving of over 20 min per scan. Accelerated imaging may prove effective in the clinical arena to evaluate patients with suspected angina.