The following is a summary of “Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease,” published in the June 2023 issue of Cardiology by Ricci et al.
Researchers conducted a retrospective study to comprehensively assess the diagnostic accuracy and prognostic value of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain and the uncertainty surrounding the low-risk period for adverse cardiovascular events after a negative test result. A thorough search was conducted from January 2000 to December 2021.
About 3,144 records were assessed for title and abstract, of which 235 articles underwent full-text assessment. Ultimately, 64 studies (encompassing 74,470 patients) published between October 29, 2002, and October 19, 2021, were considered eligible after necessary exclusions. The selected studies analyzed CMR, providing diagnostic accuracy estimates and/or raw data on adverse CV events in patients with positive or negative stress CMR results.
The combined outcome of myocardial infarction and CV death were diagnostic odds ratios (DORs), specificity, sensitivity, odds ratio (OR), area under the receiver operating characteristic curve (AUROC), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs).
The analysis included 33 diagnostic studies with 7,814 individuals and 31 prognostic studies with 67,080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381,357 person-years). Stress CMR for identifying functionally obstructive CAD showed a DOR of 26.4 (95% CI, 10.6-65.9), a specificity of 86% (95% CI, 75%-93%), a sensitivity of 81% (95% CI, 68%-89%) and an AUROC of 0.84 (95% CI, 0.77-0.89). Stress CMR indicated higher diagnostic accuracy in suspected CAD (DOR, 53.4; 95% CI, 27.7-103.0) or (DOR, 33.2; 95% CI, 19.9-55.4) using 3-T imaging in the subgroup analysis. The stress-inducible ischemia was linked with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), MACEs (OR, 5.33; 95% CI, 4.04-7.04), and CV mortality (OR, 6.40; 95% CI, 4.48-9.14). However, the late gadolinium enhancement (LGE) was linked 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). The pooled AERs for CV death were below 1.0% after a negative test result.
The analysis concluded that stress CMR indicated high diagnostic accuracy, robust prognostication, and lower risk of MACEs with normal results for at least 3.5 years, especially when 3-T scanners were utilized.