This prospective randomized diagnostic accuracy study evaluated whether an accelerated, stress-only perfusion cardiovascular magnetic resonance (CMR) protocol was non-inferior to a standard stress-rest perfusion CMR protocol for detecting significant coronary artery disease (CAD). The study included 150 patients with suspected angina referred for invasive coronary angiography (ICA) who completed both 3-Tesla CMR scans on separate days in randomized order. The mean age was 66 ± 10 years, 71% were male, and the CAD prevalence was 51%. Significant CAD was defined as a fractional flow reserve (FFR) ≤ 0.80 in epicardial vessels ≥2 mm diameter (or quantitative flow ratio ≤0.80 if FFR unavailable).
The accelerated scan was better tolerated, with a scan duration of 19 ± 5 minutes, which was 24 minutes shorter than the standard protocol (95% CI: 23, 25; P < 0.001). For the primary per-vessel analysis, accelerated CMR achieved non-inferior diagnostic accuracy compared to standard CMR at a pre-specified 5% non-inferiority margin for two independent readers (+0.7% [-2.7%, 4.0%], pnon-inferiority = 0.001 and +3.4% [-0.1%, 6.8%], pnon-inferiority < 0.001). In the secondary per-patient consensus analysis, accelerated CMR achieved comparable accuracy (+4.6% [-1.5%, 11.0%], P = 0.189), with an accuracy of 88.6%, sensitivity of 84.2%, and specificity of 93.2%.
The study concludes that the accelerated stress-perfusion protocol achieves non-inferior diagnostic accuracy at the vessel level with a time saving of over 20 minutes per scan, which may prove effective for evaluating patients with suspected angina.
If you're having chest pain and need a heart scan, you might be in for a long, uncomfortable test. The standard scan for checking blood flow to the heart takes over 40 minutes. But what if a much faster version worked just as well? A new study tested exactly that. They compared a new, accelerated scan that takes about 19 minutes to the standard, longer scan in 150 people with suspected heart artery disease. The key question was whether the faster scan could find significant blockages just as accurately. The results are promising. The accelerated scan was not inferior to the standard one at detecting which specific heart arteries were blocked. It also performed comparably at the patient level, correctly identifying about 89% of cases. Crucially, patients tolerated the faster scan better. The time saving was substantial—about 24 minutes shorter per scan. For someone lying still in a scanner, that's a big difference in comfort. This suggests that for people being evaluated for chest pain, a quicker, more tolerable scan could provide the answers doctors need without sacrificing accuracy.
What this means for you: A faster, 19-minute heart scan finds blocked arteries as accurately as the standard test and is better tolerated.
View Original Abstract ↓
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.