Clinical evaluation of magnetic resonance imaging in coronary heart disease: the CE-MARC study.
BACKGROUND
Several investigations are currently available to establish the diagnosis of coronary heart disease (CHD). Of these, cardiovascular magnetic resonance (CMR) offers the greatest information from a single test, allowing the assessment of myocardial function, perfusion, viability and coronary artery anatomy. However, data from large scale studies that prospectively evaluate the diagnostic accuracy of multi-parametric CMR for the detection of CHD in unselected populations are lacking, and there are few data on the performance of CMR compared with current diagnostic tests, its prognostic value and cost-effectiveness.


METHODS
This is a prospective diagnostic accuracy cohort study of 750 patients referred to a cardiologist with suspected CHD. Exercise tolerance testing (ETT) will be preformed if patients are physically able. Recruited patients will then undergo CMR and single photon emission tomography (SPECT) followed in all patients by invasive X-ray coronary angiography. The order of the CMR and SPECT tests will be randomised. The CMR study will comprise rest and adenosine stress perfusion, cine imaging, late gadolinium enhancement and whole-heart MR coronary angiography. SPECT will use a gated stress/rest protocol. The primary objective of the study is to determine the diagnostic accuracy of CMR in detecting significant coronary stenosis, as defined by X-ray coronary angiography. Secondary objectives include an assessment of the prognostic value of CMR imaging, a comparison of its diagnostic accuracy against SPECT and ETT, and an assessment of cost-effectiveness.


CONCLUSIONS
The CE-MARC study is a prospective, diagnostic accuracy cohort study of 750 patients assessing the performance of a multi-parametric CMR study in detecting CHD using invasive X-ray coronary angiography as the reference standard and comparing it with ETT and SPECT.


BACKGROUND
Current Controlled Trials ISRCTN77246133.
Greenwood
John P
JP
Division of Cardiovascular and Neuronal Remodelling, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds General Infirmary, Leeds, LS1 3EX, UK. j.greenwood@leeds.ac.uk
Maredia
Neil
N
Radjenovic
Aleksandra
A
Brown
Julia M
JM
Nixon
Jane
J
Farrin
Amanda J
AJ
Dickinson
Catherine
C
Younger
John F
JF
Ridgway
John P
JP
Sculpher
Mark
M
Ball
Stephen G
SG
Plein
Sven
S
D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards*; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design; D015899:Tomography, Emission-Computed, Single-Photon