Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Cardiology, 8(7), 662. https://doi.org/10.1001/jamacardio.2023.1290 Dr. Fabrizio Ricci et al.
Points
- Stress cardiovascular magnetic resonance imaging (CMR) is highly accurate in diagnosing functionally obstructive coronary artery disease, with a diagnostic odds ratio of 26.4, sensitivity of 81%, and specificity of 86%.
- When applied to patients with suspected coronary artery disease or using 3-T imaging, stress CMR demonstrates even higher diagnostic accuracy, with diagnostic odds ratios of 53.4 and 33.2, respectively.
- Stress CMR provides robust prognostication, with stress-inducible ischemia and late gadolinium enhancement (LGE) associated with significantly higher risks of all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs).
- Patients with normal stress CMR results have a lower risk of major adverse cardiovascular events for at least 3.5 years, highlighting its utility in identifying low-risk individuals.
- This comprehensive review supports the clinical value of stress CMR in diagnosing and risk-stratifying patients with stable chest pain and known or suspected coronary artery disease, aiding in more informed clinical decisions for this patient population.
Summary
The diagnostic and prognostic potential of stress cardiovascular magnetic resonance imaging (CMR) in patients with stable chest pain has been the subject of ongoing debate. A systematic review and meta-analysis of 64 studies involving a total of 74,470 patients with stable chest pain, followed over 381,357 person-years, from October 29, 2002, through October 19, 2021, aimed to provide a contemporary quantitative synthesis of the diagnostic accuracy and prognostic value of stress CMR.
The analysis revealed that stress CMR demonstrated high diagnostic accuracy, with a diagnostic odds ratio (DOR) of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81%, a specificity of 86%, and an area under the receiver operating characteristic curve (AUROC) of 0.84 for detecting functionally obstructive coronary artery disease. Subgroup analyses further indicated that stress CMR was especially effective in patients with suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) and when conducted using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4).
In terms of prognosis, stress CMR provided robust prognostication. Stress-inducible ischemia and late gadolinium enhancement (LGE) were associated with significantly higher risks of all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs). For instance, the presence of stress-inducible ischemia yielded an odds ratio (OR) of 1.97 (95% CI, 1.69-2.31) for all-cause mortality and an OR of 6.40 (95% CI, 4.48-9.14) for cardiovascular mortality. Similarly, LGE was associated with an OR of 2.22 (95% CI, 1.99-2.47) for all-cause mortality and an OR of 6.03 (95% CI, 2.76-13.13) for cardiovascular mortality.
The findings underscore the significance of stress CMR in diagnosing and risk-stratifying patients with stable chest pain and known or suspected coronary artery disease. Notably, the use of 3-T scanners further enhances its diagnostic accuracy. Notably, a normal stress CMR result was associated with a lower risk of major adverse cardiovascular events for a minimum of 3.5 years, highlighting its utility in identifying low-risk patients. These results contribute to the growing body of evidence supporting the clinical value of stress CMR in managing stable chest pain, aiding in more informed clinical decisions for patients in this population.
Link to the article: https://jamanetwork.com/journals/jamacardiology/article-abstract/2805949
References Ricci, F., Khanji, M. Y., Bisaccia, G., Cipriani, A., Di Cesare, A., Ceriello, L., Mantini, C., Zimarino, M., Fedorowski, A., Gallina, S., Petersen, S. E., & Bucciarelli-Ducci, C. (2023). Diagnostic and prognostic value of stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease: A systematic review and meta-analysis. JAMA Cardiology, 8(7), 662. https://doi.org/10.1001/jamacardio.2023.1290
