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Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly
Ibrahim Danad1,2, Jackie Szymonifka1,2, Jos W R Twisk3
1Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
Insights
Cardiac MRI demonstrated the highest diagnostic performance for detecting ischaemia-causing coronary artery disease (CAD). Functional assessments like fractional flow reserve (FFR) improved accuracy compared to purely anatomic imaging methods.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Diagnostic Performance Evaluation
Background:
- Accurate diagnosis of ischaemia-causing coronary artery disease (CAD) is crucial for guiding patient management.
- Multiple non-invasive and invasive imaging modalities exist, each with varying diagnostic capabilities.
- Direct comparison of these methods against a reference standard is essential for evidence-based clinical practice.
Purpose of the Study:
- To evaluate and compare the diagnostic performance of various cardiac imaging techniques for ischaemia-causing CAD.
- To directly compare single-photon emission computed tomography (SPECT), stress echocardiography (SE), invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), CCTA-derived fractional flow reserve (FFRCT), and cardiac magnetic resonance (MRI) against an FFR reference standard.
Main Methods:
- A systematic literature search was conducted on PubMed and Web of Knowledge for studies published between January 2002 and February 2015.
- Included studies assessed FFR in at least 75% of coronary vessels for diagnosing ischaemic CAD.
- Meta-analysis was performed on data from 23 articles (3788 patients, 5323 vessels) to pool sensitivity, specificity, and likelihood ratios, generating summary receiver operating characteristic curves.
Main Results:
- On a per-patient basis, CCTA, FFRCT, and MRI showed higher sensitivity (90%) compared to SPECT (70%), SE (77%), and ICA (69%).
- MRI exhibited the highest per-patient specificity (94%), while CCTA had the lowest (39%).
- Per-vessel analysis indicated high sensitivity for CCTA (91%), MRI (91%), and FFRCT (83%), with MRI also demonstrating the highest specificity (85%).
Conclusions:
- Cardiac MRI demonstrated superior diagnostic performance for ischaemia-causing CAD compared to SPECT and SE.
- Anatomical imaging methods (CCTA, ICA) showed lower specificity.
- Functional assessment of coronary atherosclerosis, particularly with FFRCT, SE, and SPECT, improved diagnostic accuracy.
Aims:
The aim of this study was to determine the diagnostic performance of single-photon emission computed tomography (SPECT), stress echocardiography (SE), invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), fractional flow reserve (FFR) derived from CCTA (FFRCT), and cardiac magnetic resonance (MRI) imaging when directly compared with an FFR reference standard.
Method And Results:
PubMed and Web of Knowledge were searched for investigations published between 1 January 2002 and 28 February 2015. Studies performing FFR in at least 75% of coronary vessels for the diagnosis of ischaemic coronary artery disease (CAD) were included. Twenty-three articles reporting on 3788 patients and 5323 vessels were identified. Meta-analysis was performed for pooled sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratio, and summary receiver operating characteristic curves. In contrast to ICA, CCTA, and FFRCT reports, studies evaluating SPECT, SE, and MRI were largely retrospective, single-centre and with generally smaller study samples. On a per-patient basis, the sensitivity of CCTA (90%, 95% CI: 86-93), FFRCT (90%, 95% CI: 85-93), and MRI (90%, 95% CI: 75-97) were higher than for SPECT (70%, 95% CI: 59-80), SE (77%, 95% CI: 61-88), and ICA (69%, 95% CI: 65-75). The highest and lowest per-patient specificity was observed for MRI (94%, 95% CI: 79-99) and for CCTA (39%, 95% CI: 34-44), respectively. Similar specificities were noted for SPECT (78%, 95% CI: 68-87), SE (75%, 95% CI: 63-85), FFRCT (71%, 95% CI: 65-75%), and ICA (67%, 95% CI: 63-71). On a per-vessel basis, the highest sensitivity was for CCTA (pooled sensitivity, 91%: 88-93), MRI (91%: 84-95), and FFRCT (83%, 78-87), with lower sensitivities for ICA (71%, 69-74), and SPECT (57%: 49-64). Per-vessel specificity was highest for MRI (85%, 79-89), FFRCT (78%: 78-81), and SPECT (75%: 69-80), whereas ICA (66%: 64-68) and CCTA (58%: 55-61) yielded a lower specificity.
Conclusions:
In this meta-analysis comparing cardiac imaging methods directly to FFR, MRI had the highest performance for diagnosis of ischaemia-causing CAD, with lower performance for SPECT and SE. Anatomic methods of CCTA and ICA yielded lower specificity, with functional assessment of coronary atherosclerosis by SE, SPECT, and FFRCT improving accuracy.
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