title: Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial.
abstract: Stress cardiac magnetic resonance (CMR) has typically involved pharmacologic agents. Treadmill CMR has shown utility in single-center studies but has not undergone multicenter evaluation.
  
  
  
  Patients referred for treadmill stress nuclear imaging (SPECT) were prospectively enrolled across 4 centers. After rest (99m)Tc SPECT, patients underwent resting cine CMR. In-room stress was then performed using an MR-compatible treadmill with continuous 12-lead electrocardiogram monitoring. At peak stress, (99m)Tc was injected, and patients rapidly returned to the MR scanner isocenter for real-time, free-breathing stress cine and perfusion imaging. After recovery, cine and rest perfusion followed by late gadolinium enhancement acquisitions concluded CMR imaging. Stress SPECT was then acquired in adjacent nuclear laboratories. A subset of patients not referred for invasive coronary angiography within 2 weeks of stress underwent coronary computed tomography angiography. Angiographic data available in 94 patients showed sensitivity of 79%, specificity of 99% for exercise CMR with positive predictive value of 92% and negative predictive value of 96%. Agreement between treadmill stress CMR and angiography was strong (κ=0.82), and moderate between SPECT and angiography (κ=0.46) and CMR versus SPECT (κ=0.48).
  
  
  
  The multicenter EXACT trial indicates excellent diagnostic value of treadmill stress CMR in typical patients referred for exercise SPECT.
authors.affiliation: Ohio State University Davis Heart and Lung Research Institute, Columbus, OH OSU Division of Cardiovascular Medicine, Columbus, OH OSU Department of Radiology, Columbus, OH raman.1@osu.edu.
authors.forename: Subha V
authors.initials: SV
authors.lastname: Raman
authors.affiliation: OSU Division of Cardiovascular Medicine, Columbus, OH.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Dickerson
authors.affiliation: The Christ Hospital Heart and Vascular Center, Cincinnati, OH.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mazur
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Wong
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schelbert
authors.affiliation: Department of Radiology, Weill-Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York, NY.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Ohio State University Davis Heart and Lung Research Institute, Columbus, OH.
authors.forename: Debbie
authors.initials: D
authors.lastname: Scandling
authors.affiliation: The Christ Hospital Heart and Vascular Center, Cincinnati, OH.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bartone
authors.affiliation: Ohio State University Davis Heart and Lung Research Institute, Columbus, OH.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Craft
authors.affiliation: Peter Munk Cardiac Center, University of Toronto, Toronto, Canada.
authors.forename: Paaladinesh
authors.initials: P
authors.lastname: Thavendiranathan
authors.affiliation: OSU Division of Cardiovascular Medicine, Columbus, OH.
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Mazzaferri
authors.affiliation: OSU Agricultural Technical Institute, Columbus, OH.
authors.forename: John W
authors.initials: JW
authors.lastname: Arnold
authors.affiliation: Department of Radiology, Case Western Reserve University, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Gilkeson
authors.affiliation: Ohio State University Davis Heart and Lung Research Institute, Columbus, OH OSU Division of Cardiovascular Medicine, Columbus, OH OSU Department of Radiology, Columbus, OH.
authors.forename: Orlando P
authors.initials: OP
authors.lastname: Simonetti
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: coronary disease; exercise; ischemia; magnetic resonance imaging; stress