Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial

Abstract

Background Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. Methods In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. Results In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94–1.00)] in discriminating between FFR-normal and FFR-positive patients. Conclusion The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. Trial registration: ClinicalTrials.gov, NCT03217227, Registered 11 July 2017–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart

Interaction between the left ventricular ejection fraction and left ventricular strain and its relationship with coronary stenosis

“…The LVEF, LVEDV, and LVESV are the main indicators of the ability of the heart to pump blood; furthermore, they are important for evaluating coronary heart disease and predicting the survival rate of such patients[ 13 , 14 ]. The LVEF is the ratio of the left ventricular stroke volume to the end-diastolic volume, and it is one of the core values used for the basic evaluation of cardiac function in clinical practice[ 15 ]. MRI is the gold standard for assessing the LVEF and left ventricular function in clinical practice[ 16 ].…”

Comparision of Myocardial Viability Assessment Between Cardiac Magnetic Resonance Imaging and Single Photon Emission Computed Tomography in Patients with Coronary Artery Disease

“…Thus, CMR is considered the safest and one of the most accurate, reproducible and reliable methods of determining myocardial viability in patients with reduced LV dysfunction & chronic CAD. 25…”

Highlights of the Virtual Society for Cardiovascular Magnetic Resonance 2022 Scientific Conference: CMR: improving cardiovascular care around the world

“…Exercise CMR has been used to assess obstructive CAD, dilated cardiomyopathy, and heart failure with preserved ejection fraction. Future directions in this area include the determination of systemic metabolic oxygen consumption with CMR oximetry and real-time flow imaging and post-processing to see stroke volume and cardiac output changes during exercise [ 29 , 30 , 31 ].…”