The role of cardiovascular magnetic resonance in women with suspected CAD: a CE-MARC substudy
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The role of cardiovascular magnetic resonance in women with suspected CAD: a CE-MARC substudy John P Greenwood1, Manish Motwani1*, Neil Maredia1, John Younger2, Julia Brown3, Jane Nixon3, Colin Everett3, Petra Bijsterveld1, John P Ridgway4, Aleksandra Radjenovic4, Catherine J Dickinson5, Stephen G Ball1, Sven Plein1 From 15th Annual SCMR Scientific Sessions Orlando, FL, USA. 2-5 February 2012 Summary The CE-MARC study is the largest, prospective evaluation of cardiovascular magnetic resonance (CMR) in patients with suspected coronary artery disease (CAD). This predefined CE-MARC substudy compared the diagnostic performance of CMR and single-photon emission computed tomography (SPECT) in the female cohort. Background Coronary artery disease (CAD) is the leading cause of death in women but despite this they are often underrepresented in non-invasive imaging studies. Furthermore, the use of myocardial perfusion imaging in women presents challenges not encountered in men including a low premenopausal prevalence of CAD, more atypical symptoms, a different pattern of disease (more frequent single-vessel disease and intermediate grade stenosis), breast attenuation artefacts and smaller heart size. This substudy aimed to compare the diagnostic performance of CMR and single-photon emission computed tomography (SPECT) in the female cohort of the CE-MARC study [1]. Methods CE-MARC was a prospective study of 752 patients with suspected CAD. All patients were scheduled to undergo CMR and SPECT followed by invasive coronary angiography (the reference standard). CMR comprised adenosine stress/rest perfusion, cine imaging, late gadolinium enhancement and MR coronary angiography. Gated adenosine stress/rest SPECT was performed using 99mTc 1
Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK Full list of author information is available at the end of the article
tetrofosmin. Visual analysis was performed on a per patient basis. For this pre-defined substudy, the diagnostic accuracy of CMR and SPECT to detect significant CAD in the female cohort (n = 281) was compared using McNemar’s Chi-Squared Test and Leisenring’s Generalised Score Statistic. In a secondary analysis, receiver operating characteristic curves were generated for the stress perfusion CMR component and SPECT (using a summed stress scores for both).
Results 235 female patients had interpretable CMR, SPECT and angiography. The prevalence of significant CAD was 22.6% (1VD 14.9%; 2VD 6.0%; 3VD 1.7%). The sensitivity of a multi-parametric CMR study was 88.7% (95%CI: 77.4-94.7), specificity 83.5% (95%CI: 77.4-88.2), positive predictive value (PPV) 61.0% (95%CI: 49.9-71.2) and negative predictive value (NPV) 96.2% (95%CI: 92.098.2). For SPECT the sensitivity was 50.9% (95%CI: 37.9-63.9), specificity 84.1% (95%CI: 78.1-88.7), PPV 48.2% (95%CI: 35.7-61.0) and NPV 85.5% (95%CI: 79.689.9). The differences between the sensitivity and NPV of CMR and SPECT we
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