PMID- 26174854 OWN - NLM STAT- MEDLINE DCOM- 20160321 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 17 IP - 1 DP - 2015 Jul 15 TI - Individual component analysis of the multi-parametric cardiovascular magnetic resonance protocol in the CE-MARC trial. PG - 59 LID - 10.1186/s12968-015-0169-2 [doi] LID - 59 AB - 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. FAU - Ripley, David P AU - Ripley DP AD - Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. d.ripley@leeds.ac.uk. FAU - Motwani, Manish AU - Motwani M AD - Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. m.motwani@leeds.ac.uk. FAU - Brown, Julia M AU - Brown JM AD - Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71-75 Clarendon Rd, Leeds, UK. j.m.b.brown@leeds.ac.uk. FAU - Nixon, Jane AU - Nixon J AD - Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71-75 Clarendon Rd, Leeds, UK. j.e.nixon@leeds.ac.uk. FAU - Everett, Colin C AU - Everett CC AD - Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71-75 Clarendon Rd, Leeds, UK. c.c.everett@leeds.ac.uk. FAU - Bijsterveld, Petra AU - Bijsterveld P AD - Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. p.bijsterveld@leeds.ac.uk. FAU - Maredia, Neil AU - Maredia N AD - Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. neil.maredia@stees.nhs.uk. FAU - Plein, Sven AU - Plein S AD - Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. s.plein@leeds.ac.uk. FAU - Greenwood, John P AU - Greenwood JP AD - Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. j.greenwood@leeds.ac.uk. LA - eng SI - ISRCTN/ISRCTN77246133 GR - FS/10/62/28409/BHF_/British Heart Foundation/United Kingdom GR - SP/12/1/29062/BHF_/British Heart Foundation/United Kingdom GR - FS/10/62/2840/British Heart Foundation/United Kingdom GR - RG/05/004/British Heart Foundation/United Kingdom PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20150715 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 SB - IM MH - Aged MH - Coronary Angiography/*methods MH - Coronary Artery Disease/*diagnosis/pathology/physiopathology MH - *Coronary Circulation MH - Coronary Vessels/*pathology/*physiopathology MH - Female MH - Humans MH - Magnetic Resonance Angiography/*methods MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Myocardial Perfusion Imaging/*methods MH - Predictive Value of Tests MH - Prospective Studies MH - Reproducibility of Results MH - Ventricular Function, Left PMC - PMC4502933 EDAT- 2015/07/16 06:00 MHDA- 2016/03/22 06:00 PMCR- 2015/07/15 CRDT- 2015/07/16 06:00 PHST- 2015/02/25 00:00 [received] PHST- 2015/07/01 00:00 [accepted] PHST- 2015/07/16 06:00 [entrez] PHST- 2015/07/16 06:00 [pubmed] PHST- 2016/03/22 06:00 [medline] PHST- 2015/07/15 00:00 [pmc-release] AID - S1097-6647(23)00884-0 [pii] AID - 169 [pii] AID - 10.1186/s12968-015-0169-2 [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2015 Jul 15;17(1):59. doi: 10.1186/s12968-015-0169-2.