Comparison of Cardiovascular Magnetic Resonance and Single-Photon Emission Computed Tomography in Women with Suspected Coronary Artery Disease from the CE-MARC Trial

Background — Coronary artery disease (CAD) is the leading cause of death in women and under-diagnosis contributes to their high mortality. This study compared the gender-specific diagnostic performance of cardiovascular magnetic resonance (CMR) and single-photon emission computed tomography (SPECT). Methods and Results — 235 females and 393 males with suspected angina underwent CMR, SPECT and X-ray angiography as part of the CE-MARC study. CMR comprised adenosine stress/rest perfusion, cine imaging, late gadolinium enhancement and MR coronary angiography. Gated adenosine stress/rest SPECT was performed using 99m Tc-tetrofosmin. For CMR, the sensitivity in females and males was similar (88.7% vs. 85.6%, p=0.57), as was the specificity (83.5% vs. 82.8%, p=0.86). For SPECT, the sensitivity was significantly worse in females than males (50.9% vs. 70.8%, p=0.007), but specificities were similar (84.1% vs. 81.3%; p=0.48). Sensitivity in both female and male groups was significantly higher with CMR than SPECT (p<0.0001 for both) but specificity was similar (p=0.77 and 1.00 respectively). For perfusion-only components, CMR outperformed SPECT in females (area under curve [AUC]: 0.90 vs. 0.67, p<0.0001) and in males (AUC: 0.89 vs. 0.74, p<0.0001). Diagnostic accuracy was similar in both sexes with perfusion CMR (p=1.00), but significantly worse in females with SPECT (p<0.0001). CMR. n cccritititereriaii wwwererre as prprevevevioioioususulylyy pppubuublilishshsheded 1111,1122 . ThThhee e stststudududy yy wawaas ss apapappprprovovovededd bbby y ththheee lololocacaal ll eetethihihicscsc cccommmmimimittttteeeee aaandndnd ccomommplpliieiedd d with the Decclalaararaatitiiononon ooof f HeHeelslslsinininkikiki (((2020200000).).). PaPaPatititenenentstst ppprororovivdededed d d inininfofoformrmrmededd wwwriririttttttenenen cconononsesesentntn.. CCCararrdidiiovovovasasscuuulalar rr mmamagngngnetetetic rreessononanancec and d sisingnlele-p-phootoon ememiissiionon ccomompuputetd toomomogrgrapphyh foor r didiagagnonosiss ofof ccororonnarary hehearat didisesasse e (C(CE-E-MARC): a ppproroospspspececectititivevee tttrialalal.. . Superior didiiagaggnnostic pperererfoformrmrmanancecece ooofff pepeprfrffusususioioion-n-cacacardrdrioioovavavascsculullaarr mmagagagnenenetititic rereresosoonananancncceee vevrsrsususus SSSPEPEPCTCTT tttooo dededetetect coorooonanry arterry y diddssseasasse:e TTThhehe ssseececononnddadarryy eendppopointss oof thhheee mumuulttticiceenntteer r mmuullttivvenenendodor r MRMRMR-I-IIMMPMPACACACT III (MMMagneticc RRessonnanncece Imamaagigiingng fororr MMMyyyocaaardddial PPeererfufuusisisioonon AAAsseeessssmennnt iinin CCCoororonoarrryy AArrteeery DiDiseseseasassee e TrTrriaiaial)ll).. MMMagagagnnn ReResososonnn TaTaTassksk FFororrcecec oon CCCoomommittee to o UUpUdadatetee thehehe 11199999977 ExExExeerercciisee Teeestting GGGuiddedellilinenees).).) aratitclle:e:e aa iriricacaan oofof TaTasssk ooonnn (((CoCoCommmmmmitititteteee