Comparison of stress cardiovascular magnetic resonance imaging (CMR) with stress nuclear perfusion for the diagnosis of coronary artery disease

Ijaz G Ahmad, Raushan K Abdulla, Igor Klem, Roman Margulis, Alexander Ivanov, Ambreen Mohamed, Robert M Judd, Salvatore Borges-Neto, Raymond J Kim, John F Heitner

To assess the diagnostic performance of stress cardiac magnetic resonance (stress CMR) vs stress single-photon emission computed tomography (SPECT) in patients presenting to the emergency department (ED) with chest pain. SPECT imaging is the most utilized outpatient procedure in the United States. The diagnostic accuracy of SPECT can be limited by soft tissue attenuation and low spatial resolution. Stress CMR has much higher spatial resolution and without the susceptibility to soft tissue attenuation. Eighty-seven patients without a history of CAD presenting to the ED with chest pain were prospectively enrolled. Patients underwent both stress CMR and stress SPECT imaging within 12 hours of presentation. Both the stress imaging tests were interpreted immediately for clinical purposes and coronary angiography was performed if either was abnormal. Patients were considered to have significant CAD if identified by angiography (≥50%) or if a cardiac event (cardiac death, myocardial infarction or revascularization) occurred during follow-up (mean 2.6 ± 1.1 years). Thirty-seven patients were referred for coronary angiography; 29 due to a positive stress test and eight patients for persistent chest pain despite two negative stress tests. There were 22 patients who had significant CAD (≥50%). The remaining patients were followed for 2.6 ± 1.1 years. At the conclusion of the follow-up period, there were four clinical events. The sensitivity, specificity, and diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%, 91%, and 88%, respectively. Stress CMR has similar diagnostic accuracy as stress SPECT in diagnosis of CAD.