Diagnostic and prognostic comparison of stress electrocardiogram, cardiovascular magnetic resonance, and single photon emission computed tomography, alone and sequentially, in stable chest pain.

Bisaccia, G.; Swoboda, PP.; Younger, JF.; Maredia, N.; Dickinson, CJ.; Brown, JM.; Bucciarelli-Ducci, C.; Plein, S.; Greenwood, JP.

Diagnostic and prognostic comparison of stress electrocardiogram, cardiovascular magnetic resonance, and single photon emission computed tomography, alone and sequentially, in stable chest pain.

All Authors

Bisaccia, G.

Swoboda, PP.

Younger, JF.

Maredia, N.

Dickinson, CJ.

Brown, JM.

Bucciarelli-Ducci, C.

Plein, S.

Greenwood, JP.

LTHT Author

Dickinson, Catherine
Plein, Sven
Greenwood, John

LTHT Department

Cardio-Respiratory
Cardiology

Publication Date

2025

Item Type

Journal Article
Comparative Study
Randomised Controlled Trial
Multicenter Study

Abstract

BACKGROUND: Exercise electrocardiogram (ECG) remains widely performed in the assessment of patients with suspected cardiac chest pain. We aimed to assess the comparative diagnostic and prognostic yield of exercise ECG, single photon emission computed tomography (SPECT), and cardiovascular magnetic resonance (CMR), in a large prospective patient population. METHODS: Patients recruited to Clinical Evaluation of MAgnetic Resonance in Coronary heart disease (CE-MARC) who had exercise ECG were included and followed up to a median (interquartile range) of 6.3 (0.1, 6.8) years. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for diagnostic accuracy were derived and hazard ratios of major adverse cardiovascular events (MACE) for prognostic significance were calculated. RESULTS: Of 752 patients in the CE-MARC trial, 580 had exercise ECG and invasive coronary angiography, of which 503 also had SPECT and CMR. At follow-up, a total of 91 (15.7%) patients experienced MACE. Using invasive angiography as the reference test, the sensitivity, specificity, PPV, and NPV (95% confidence interval) of exercise ECG were 68.3 (61.9, 74.0), 72.5 (67.6, 76.9), 61.0 (54.8, 66.8), 78.4 (73.7, 82.5). Exercise ECG was significantly less sensitive than CMR and less specific than both CMR and SPECT. A positive exercise ECG result was not predictive of MACE at follow-up (Hazard ratio 1.14 [0.75, 1.72], p = 0.53). CMR had both a greater diagnostic and prognostic yield than exercise ECG, SPECT, and their combination. Sequential CMR following inconclusive exercise ECG was comparable to CMR alone as the first-line test. CONCLUSION: In patients with suspected angina, CMR alone as the first-line test was more sensitive and prognostically accurate than exercise ECG, SPECT, or sequential combination of both tests.