- Oral presentation
- Open Access
Cardiovascular magnetic resonance stress perfusion compared to single-photon emission computed tomography (SPECT) in patients with left main stem disease: a CE-MARC substudy
© Greenwood et al; licensee BioMed Central Ltd. 2012
- Published: 1 February 2012
- Cardiovascular Magnetic Resonance
- Leave Anterior Descend
- Single Photon Emission Tomography
- Stress Perfusion
- Cardiovascular Magnetic Resonance Perfusion
We compared detection rates for cardiovascular magnetic resonance (CMR) perfusion and single photon emission tomography (SPECT) in the subset of patients from the CE-MARC study with significant left main stem (LMS) disease. Detection rates for LMS disease by CMR perfusion were higher than for SPECT, and CMR identified a classical LMS pattern with higher frequency. Visual perfusion defects occurred with similar frequency in patients with ≥50% and ≥70% LMS stenosis.
Left main stem (LMS) disease is found in approximately 5% of patients with stable angina. Three-year survival in patients with >50% left main stenosis may be as low as 50%. Single photon emission tomography (SPECT) fails to detect ischemia in up to 15% of LMS stenoses, and identification of the ‘classical’ pattern of both left anterior descending (LAD) and circumflex (LCx) coronary territory ischaemia is lower still. To date, the utility of cardiovascular magnetic resonance (CMR) perfusion in LMS disease is poorly established. The CE-MARC study was a prospective study of 752 patients with suspected coronary artery disease, enrolled to undergo CMR, SPECT and X-ray coronary angiography. We assessed the diagnostic performance of SPECT and CMR to detect LMS disease in the group of CE-MARC patients with ≥50% LMS disease on quantitative X-ray angiography. We also compared subsets of patients with ≥50% and ≥70% LMS stenosis.
All patients with LMS disease ≥50% on quantitative angiography were identified from the CE-MARC study. All patients had undergone adenosine stress perfusion by CMR and SPECT and also invasive X-ray angiography . By visual analysis we compared detection rates for LMS disease from the CMR and SPECT perfusion studies.
CMR stress perfusion imaging identifies ischaemia in a higher proportion of patients with significant LMS disease than SPECT, and identifies a ‘classical’ LMS pattern with higher frequency. Perfusion abnormalities are detected with similar frequency in patients with ≥50% and ≥70% LMS stenosis.
The CE-MARC study was funded by a British Heart Foundation Programme Grant (RG/05/004). S.P is funded by British Heart Foundation fellowship (FS/10/62/28409).
- Greenwood JP: CE-MARC, et al: A Prospective Evaluation of Cardiovascular Magnetic Resonance and Single-Photon Emission Computed Tomography in Coronary Heart Disease. The Lancet. 2011,Google Scholar
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