Giandomenico Bisaccia, Peter P Swoboda, John F Younger, Neil Maredia, Catherine J Dickinson, Julia M Brown, Chiara Bucciarelli-Ducci, Sven Plein, John P Greenwood
{"title":"稳定型胸痛的应激心电图、CMR和SPECT单独和顺序诊断和预后比较。","authors":"Giandomenico Bisaccia, Peter P Swoboda, John F Younger, Neil Maredia, Catherine J Dickinson, Julia M Brown, Chiara Bucciarelli-Ducci, Sven Plein, John P Greenwood","doi":"10.1016/j.jocmr.2025.101960","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Exercise ECG remains widely performed in the assessment of patients with suspected cardiac chest pain. We aimed to assess the comparative diagnostic and prognostic yield of exercise ECG, single photon emission computed tomography (SPECT) and cardiovascular magnetic resonance (CMR), in a large prospective patient population.</p><p><strong>Methods: </strong>Patients recruited to CE-MARC who had exercise ECG were included and followed up to a median(IQR) of 6.3(0.1,6.8) years. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and area under the curve (AUC) for diagnostic accuracy were derived and hazard ratios of MACE for prognostic significance calculated.</p><p><strong>Results: </strong>Of 752 patients in the CE-MARC trial, 580 had exercise ECG and invasive coronary angiography, of which 503 also had SPECT and CMR. At follow-up, a total of 91(15.7%) patients experienced MACE. Using invasive angiography as the reference test, the sensitivity, specificity, PPV and NPV(95%CI) of exercise ECG were 68.3(61.9,74.0), 72.5(67.6,76.9), 61.0(54.8,66.8), 78.4(73.7,82.5). Exercise ECG was significantly less sensitive than CMR and less specific than both CMR and SPECT. A positive exercise ECG result was not predictive of MACE at follow-up (HR 1.14[0.75,1.72], p=0.53). CMR had both a greater diagnostic and prognostic yield than exercise ECG, SPECT and their combination. Sequential CMR following inconclusive exercise ECG was comparable to CMR alone as the first-line test.</p><p><strong>Conclusions: </strong>In patients with suspected angina, CMR alone as the first-line test was more sensitive and prognostically accurate than exercise ECG, SPECT, or sequential combination of both tests.</p><p><strong>Condensed abstract: </strong>In a real-world head-to-head comparison study for diagnostic accuracy and prognostic yield, a strategy of CMR alone outperformed SPECT and exercise ECG, as well as their combination, in patients with stable chest pain. Use of CMR following an inconclusive exercise ECG was superior to use of SPECT, and comparable to a strategy of CMR alone.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101960"},"PeriodicalIF":6.1000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic and prognostic comparison of stress ECG, CMR and SPECT, alone and sequentially, in stable chest pain.\",\"authors\":\"Giandomenico Bisaccia, Peter P Swoboda, John F Younger, Neil Maredia, Catherine J Dickinson, Julia M Brown, Chiara Bucciarelli-Ducci, Sven Plein, John P Greenwood\",\"doi\":\"10.1016/j.jocmr.2025.101960\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Exercise ECG remains widely performed in the assessment of patients with suspected cardiac chest pain. We aimed to assess the comparative diagnostic and prognostic yield of exercise ECG, single photon emission computed tomography (SPECT) and cardiovascular magnetic resonance (CMR), in a large prospective patient population.</p><p><strong>Methods: </strong>Patients recruited to CE-MARC who had exercise ECG were included and followed up to a median(IQR) of 6.3(0.1,6.8) years. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and area under the curve (AUC) for diagnostic accuracy were derived and hazard ratios of MACE for prognostic significance calculated.</p><p><strong>Results: </strong>Of 752 patients in the CE-MARC trial, 580 had exercise ECG and invasive coronary angiography, of which 503 also had SPECT and CMR. At follow-up, a total of 91(15.7%) patients experienced MACE. Using invasive angiography as the reference test, the sensitivity, specificity, PPV and NPV(95%CI) of exercise ECG were 68.3(61.9,74.0), 72.5(67.6,76.9), 61.0(54.8,66.8), 78.4(73.7,82.5). Exercise ECG was significantly less sensitive than CMR and less specific than both CMR and SPECT. A positive exercise ECG result was not predictive of MACE at follow-up (HR 1.14[0.75,1.72], p=0.53). CMR had both a greater diagnostic and prognostic yield than exercise ECG, SPECT and their combination. Sequential CMR following inconclusive exercise ECG was comparable to CMR alone as the first-line test.</p><p><strong>Conclusions: </strong>In patients with suspected angina, CMR alone as the first-line test was more sensitive and prognostically accurate than exercise ECG, SPECT, or sequential combination of both tests.</p><p><strong>Condensed abstract: </strong>In a real-world head-to-head comparison study for diagnostic accuracy and prognostic yield, a strategy of CMR alone outperformed SPECT and exercise ECG, as well as their combination, in patients with stable chest pain. 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Diagnostic and prognostic comparison of stress ECG, CMR and SPECT, alone and sequentially, in stable chest pain.
Background: Exercise ECG remains widely performed in the assessment of patients with suspected cardiac chest pain. We aimed to assess the comparative diagnostic and prognostic yield of exercise ECG, single photon emission computed tomography (SPECT) and cardiovascular magnetic resonance (CMR), in a large prospective patient population.
Methods: Patients recruited to CE-MARC who had exercise ECG were included and followed up to a median(IQR) of 6.3(0.1,6.8) years. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and area under the curve (AUC) for diagnostic accuracy were derived and hazard ratios of MACE for prognostic significance calculated.
Results: Of 752 patients in the CE-MARC trial, 580 had exercise ECG and invasive coronary angiography, of which 503 also had SPECT and CMR. At follow-up, a total of 91(15.7%) patients experienced MACE. Using invasive angiography as the reference test, the sensitivity, specificity, PPV and NPV(95%CI) of exercise ECG were 68.3(61.9,74.0), 72.5(67.6,76.9), 61.0(54.8,66.8), 78.4(73.7,82.5). Exercise ECG was significantly less sensitive than CMR and less specific than both CMR and SPECT. A positive exercise ECG result was not predictive of MACE at follow-up (HR 1.14[0.75,1.72], p=0.53). CMR had both a greater diagnostic and prognostic yield than exercise ECG, SPECT and their combination. Sequential CMR following inconclusive exercise ECG was comparable to CMR alone as the first-line test.
Conclusions: In patients with suspected angina, CMR alone as the first-line test was more sensitive and prognostically accurate than exercise ECG, SPECT, or sequential combination of both tests.
Condensed abstract: In a real-world head-to-head comparison study for diagnostic accuracy and prognostic yield, a strategy of CMR alone outperformed SPECT and exercise ECG, as well as their combination, in patients with stable chest pain. Use of CMR following an inconclusive exercise ECG was superior to use of SPECT, and comparable to a strategy of CMR alone.
期刊介绍：
Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to:
New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system.
New methods to enhance or accelerate image acquisition and data analysis.
Results of multicenter, or larger single-center studies that provide insight into the utility of CMR.
Basic biological perceptions derived by CMR methods.
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