Accelerated stress CMR for the detection of significant coronary artery disease: a prospective randomized diagnostic accuracy study

作者：Mohamed Elshibly, Simran Shergill, Anju Velvet, Aisha Gohar, S. Pattani, Kelly Parke, Rachel England, Aida Moafi, G. Hudson, Jeffrey Khoo, Declan P. O’Regan, Olívia Wu, David Adlam, Peter Kellman, Alasdair McIntosh, Alex McConnachie, Andrew Ladwiniec, Gerry P McCann, Jayanth R. Arnold · 发表于：European Heart Journal - Cardiovascular Imaging · 年份：2025 · DOI：10.1093/ehjci/jeaf322 · 被引用次数：1 · 研究领域：Cardiac Imaging and Diagnostics、Coronary Interventions and Diagnostics、Cardiovascular Disease and Adiposity

AIMS: In patients with suspected coronary artery disease (CAD), the role of adenosine-stress cardiovascular magnetic resonance (CMR) is well established. However, to meet increasing demand, improving its time efficiency and cost-effectiveness is critical. Recent advances in accelerated, free-breathing cine and scar imaging now enable accelerated stress-perfusion protocols. This study evaluated whether an accelerated, stress-only perfusion protocol achieves non-inferior diagnostic accuracy compared with a standard stress-rest perfusion CMR protocol for detecting significant CAD. METHODS AND RESULTS: Patients with suspected angina referred for invasive coronary angiography (ICA) underwent two 3-Tesla CMR scans (standard and accelerated protocols), on separate days in randomized order. Significant CAD was defined as fractional flow reserve (FFR) ≤ 0.80 in epicardial vessels ≥2 mm diameter (or quantitative flow ratio ≤0.80 if FFR unavailable). CMR images were evaluated qualitatively with (i) primary per-vessel analysis (determined by two independent readers) and (ii) secondary per-patient analysis (following consensus read). Of 167 prospectively recruited patients, 150 completed both CMR protocols and ICA (mean age 66 ± 10 years, 71% male, CAD prevalence 51%). The accelerated scan was better tolerated by patients, with scan duration 19 ± 5 min (24 min shorter than the standard protocol [95% CI: 23, 25], P < 0.001). Compared with standard CMR, accelerated CMR achieved non-inferior...