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Title: Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial
Authors: Le, TT 
Ang, BWY
Bryant, JA 
Chin, CY 
Yeo, KK 
Wong, PEH 
Ho, KW 
Tan, JWC 
Lee, PT 
Chin, CWL 
Cook, SA 
Keywords: Cardiovascular magnetic resonance
Coronary artery disease
Exercise stress
Fractional flow reserve
Supine cycle ergometer
Coronary Angiography
Coronary Artery Disease
Exercise Test
Fractional Flow Reserve, Myocardial
Magnetic Resonance Imaging, Cine
Middle Aged
Perfusion Imaging
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Issue Date: 1-Dec-2021
Publisher: Springer Science and Business Media LLC
Citation: Le, TT, Ang, BWY, Bryant, JA, Chin, CY, Yeo, KK, Wong, PEH, Ho, KW, Tan, JWC, Lee, PT, Chin, CWL, Cook, SA (2021-12-01). Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial. Journal of Cardiovascular Magnetic Resonance 23 (1) : 17-. ScholarBank@NUS Repository.
Abstract: Background: Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. Methods: In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. Results: In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94–1.00)] in discriminating between FFR-normal and FFR-positive patients. Conclusion: The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. Trial registration:, NCT03217227, Registered 11 July 2017–Retrospectively registered,
Source Title: Journal of Cardiovascular Magnetic Resonance
ISSN: 1097-6647
DOI: 10.1186/s12968-021-00705-8
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