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Randomized Controlled Trial
. 2015 Jul 15;17(1):59.
doi: 10.1186/s12968-015-0169-2.

Individual component analysis of the multi-parametric cardiovascular magnetic resonance protocol in the CE-MARC trial

David P Ripley  1 , Manish Motwani  2 , Julia M Brown  3 , Jane Nixon  4 , Colin C Everett  5 , Petra Bijsterveld  6 , Neil Maredia  7 , Sven Plein  8 , John P Greenwood  9
Affiliations
Randomized Controlled Trial

Individual component analysis of the multi-parametric cardiovascular magnetic resonance protocol in the CE-MARC trial

David P Ripley et al. J Cardiovasc Magn Reson. .

Abstract

Background: The CE-MARC study assessed the diagnostic performance investigated the use of cardiovascular magnetic resonance (CMR) in patients with suspected coronary artery disease (CAD). The study used a multi-parametric CMR protocol assessing 4 components: i) left ventricular function; ii) myocardial perfusion; iii) viability (late gadolinium enhancement (LGE)) and iv) coronary magnetic resonance angiography (MRA). In this pre-specified CE-MARC sub-study we assessed the diagnostic accuracy of the individual CMR components and their combinations.

Methods: All patients from the CE-MARC population (n = 752) were included using data from the original blinded-read. The four individual core components of the CMR protocol was determined separately and then in paired and triplet combinations. Results were then compared to the full multi-parametric protocol.

Results: CMR and X-ray angiography results were available in 676 patients. The maximum sensitivity for the detection of significant CAD by CMR was achieved when all four components were used (86.5%). Specificity of perfusion (91.8%), function (93.7%) and LGE (95.8%) on its own was significantly better than specificity of the multi-parametric protocol (83.4%) (all P < 0.0001) but with the penalty of decreased sensitivity (86.5% vs. 76.9%, 47.4% and 40.8% respectively). The full multi-parametric protocol was the optimum to rule-out significant CAD (Likelihood Ratio negative (LR-) 0.16) and the LGE component alone was the best to rue-in CAD (LR+ 9.81). Overall diagnostic accuracy was similar with the full multi-parametric protocol (85.9%) compared to paired and triplet combinations. The use of coronary MRA within the full multi-parametric protocol had no additional diagnostic benefit compared to the perfusion/function/LGE combination (overall accuracy 84.6% vs. 84.2% (P = 0.5316); LR- 0.16 vs. 0.21; LR+ 5.21 vs. 5.77).

Conclusions: From this pre-specified sub-analysis of the CE-MARC study, the full multi-parametric protocol had the highest sensitivity and was the optimal approach to rule-out significant CAD. The LGE component alone was the optimal rule-in strategy. Finally the inclusion of coronary MRA provided no additional benefit when compared to the combination of perfusion/function/LGE.

Trial registration: Current Controlled Trials ISRCTN77246133.

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Figures

Fig 1
Fig 1
Diagnostic accuracy of the individual components and their combinations compared to the full multi-parametric CMR examination. Cine – Cine imaging; LGE – late gadolinium enhancement; Perf –perfusion imaging; MRA – magnetic resonance coronary angiography
See this image and copyright information in PMC

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