Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial
BackgroundStress cardiac magnetic resonance (CMR) has typically involved pharmacologic agents. Treadmill CMR has shown utility in single‐center studies but has not undergone multicenter evaluation. Methods and ResultsPatients referred for treadmill stress nuclear imaging (SPECT) were prospectively e...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003811 |
| _version_ | 1818774919069040640 |
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| author | Subha V. Raman Jennifer A. Dickerson Wojciech Mazur Timothy C. Wong Erik B. Schelbert James K. Min Debbie Scandling Cheryl Bartone Jason T. Craft Paaladinesh Thavendiranathan Ernest L. Mazzaferri John W. Arnold Robert Gilkeson Orlando P. Simonetti |
| author_facet | Subha V. Raman Jennifer A. Dickerson Wojciech Mazur Timothy C. Wong Erik B. Schelbert James K. Min Debbie Scandling Cheryl Bartone Jason T. Craft Paaladinesh Thavendiranathan Ernest L. Mazzaferri John W. Arnold Robert Gilkeson Orlando P. Simonetti |
| author_sort | Subha V. Raman |
| collection | DOAJ |
| description | BackgroundStress cardiac magnetic resonance (CMR) has typically involved pharmacologic agents. Treadmill CMR has shown utility in single‐center studies but has not undergone multicenter evaluation. Methods and ResultsPatients referred for treadmill stress nuclear imaging (SPECT) were prospectively enrolled across 4 centers. After rest 99mTc 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, 99mTc 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). ConclusionsThe multicenter EXACT trial indicates excellent diagnostic value of treadmill stress CMR in typical patients referred for exercise SPECT. |
| first_indexed | 2024-12-18T10:48:47Z |
| format | Article |
| id | doaj.art-ad787eabf5a04797968e5828dbd851d8 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T10:48:47Z |
| publishDate | 2016-08-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ad787eabf5a04797968e5828dbd851d82022-12-21T21:10:30ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-08-015810.1161/JAHA.116.003811Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) TrialSubha V. Raman0Jennifer A. Dickerson1Wojciech Mazur2Timothy C. Wong3Erik B. Schelbert4James K. Min5Debbie Scandling6Cheryl Bartone7Jason T. Craft8Paaladinesh Thavendiranathan9Ernest L. Mazzaferri10John W. Arnold11Robert Gilkeson12Orlando P. Simonetti13Ohio State University Davis Heart and Lung Research Institute, Columbus, OHOSU Division of Cardiovascular Medicine, Columbus, OHThe Christ Hospital Heart and Vascular Center, Cincinnati, OHUniversity of Pittsburgh Medical Center, Pittsburgh, PAUniversity of Pittsburgh Medical Center, Pittsburgh, PADepartment of Radiology, Weill‐Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York, NYOhio State University Davis Heart and Lung Research Institute, Columbus, OHThe Christ Hospital Heart and Vascular Center, Cincinnati, OHOhio State University Davis Heart and Lung Research Institute, Columbus, OHPeter Munk Cardiac Center, University of Toronto, Toronto, CanadaOSU Division of Cardiovascular Medicine, Columbus, OHOSU Agricultural Technical Institute, Columbus, OHDepartment of Radiology, Case Western Reserve University, Cleveland, OHOhio State University Davis Heart and Lung Research Institute, Columbus, OHBackgroundStress cardiac magnetic resonance (CMR) has typically involved pharmacologic agents. Treadmill CMR has shown utility in single‐center studies but has not undergone multicenter evaluation. Methods and ResultsPatients referred for treadmill stress nuclear imaging (SPECT) were prospectively enrolled across 4 centers. After rest 99mTc 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, 99mTc 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). ConclusionsThe multicenter EXACT trial indicates excellent diagnostic value of treadmill stress CMR in typical patients referred for exercise SPECT.https://www.ahajournals.org/doi/10.1161/JAHA.116.003811coronary diseaseexerciseischemiamagnetic resonance imagingstress |
| spellingShingle | Subha V. Raman Jennifer A. Dickerson Wojciech Mazur Timothy C. Wong Erik B. Schelbert James K. Min Debbie Scandling Cheryl Bartone Jason T. Craft Paaladinesh Thavendiranathan Ernest L. Mazzaferri John W. Arnold Robert Gilkeson Orlando P. Simonetti Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary disease exercise ischemia magnetic resonance imaging stress |
| title | Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial |
| title_full | Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial |
| title_fullStr | Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial |
| title_full_unstemmed | Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial |
| title_short | Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial |
| title_sort | diagnostic performance of treadmill exercise cardiac magnetic resonance the prospective multicenter exercise cmr s accuracy for cardiovascular stress testing exact trial |
| topic | coronary disease exercise ischemia magnetic resonance imaging stress |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003811 |
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