Diagnostic performance of stress perfusion cardiac magnetic resonance for the detection of coronary artery disease

• Published in: International journal of cardiology Vol. 252; pp. 229 - 233
• Main Authors: Kiaos, Apostolos, Tziatzios, Ioannis, Hadjimiltiades, Stavros, Karvounis, Charalambos, Karamitsos, Theodoros D.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.02.2018
• Subjects: Cardiovascular magnetic resonance; Coronary artery disease; Diagnostic accuracy meta-analysis; Stress perfusion; Stress perfusion; Cardiovascular magnetic resonance; Coronary artery disease; Diagnostic accuracy meta-analysis
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.11.066

The purpose of this study was to investigate the accuracy of qualitative stress perfusion cardiac magnetic resonance (CMR) to diagnose ischemia-causing lesions according to different definitions of significant coronary artery disease (CAD), and magnetic field strength. We searched PubMed, Web of Science, and the Cochrane Library for studies evaluating diagnostic performance of qualitative stress perfusion CMR for diagnosis of CAD versus coronary angiography or fractional flow reserve (FFR) from inception to 10 September 2017. We used hierarchical models to synthesize the available data. Sixty-seven studies (7113 patients) met the inclusion criteria. The patient-based analysis of studies using FFR as the reference standard demonstrated a mean sensitivity of 0.90 (95% confidence interval [CI], 0.85–0.93) and a mean specificity of 0.85 (95% CI, 0.80–0.89). The patient-based analyses for detecting coronary stenosis ≥50% and coronary stenosis ≥70% at 1.5T and for detecting coronary stenosis ≥50% and coronary stenosis ≥70%, at 3T, demonstrated a mean sensitivity of 0.82 (95% CI, 0.79–0.84), 0.86 (95% CI, 0.83–0.89), 0.90 (95% CI, 0.82–0.95), and 0.91 (95% CI, 0.79–0.96), respectively; with a mean specificity of 0.75 (95% CI, 0.71–0.80), 0.77 (95% CI, 0.71–0.81), 0.79 (95% CI, 0.69–0.86), and 0.74 (95% CI, 0.59–0.85). Qualitative stress perfusion CMR has high accuracy for the diagnosis of CAD, irrespective of the reference standard and the magnet strength. Studies using FFR as the reference standard had higher diagnostic accuracy on a patient level compared to studies using coronary angiography, with a notable difference in specificity. •Stress perfusion CMR with visual analysis has high accuracy for the diagnosis of coronary artery disease at 1.5 or 3 Tesla•The high diagnostic performance of stress perfusion CMR is evident at both the patient and artery level•Studies using fractional flow reserve as the reference standard showed higher diagnostic accuracy on a patient level