Accelerated stress cardiovascular magnetic resonance (CMR) for the detection of significant coronary artery disease: a prospective randomized diagnostic accuracy study
Authors' conclusion
Compared to standard stress-perfusion CMR, an accelerated stress-perfusion protocol achieves non-inferior diagnostic accuracy at the vessel level, with a time saving of over 20 min per scan. Accelerated imaging may prove effective in the clinical arena to evaluate patients with suspected angina.
Study context
- Population
- Patients with suspected angina referred for invasive coronary angiography (ICA)completed both CMR protocols and ICA, of 167 prospectively recruited patients
- Participants
- 150 patients
- Comparison
- Accelerated stress-only perfusion CMR vs standard stress-rest perfusion CMR for detecting significant coronary artery disease (CAD) (fractional flow reserve (FFR) ≤ 0.80 in epicardial vessels ≥2 mm diameter, or quantitative flow ratio ≤0.80 if FFR unavailable)
Methodological detailstwo 3-Tesla CMR scans on separate days in randomized order, pre-specified 5% non-inferiority margin, two independent readers
- Two 3-Tesla CMR scans on separate days in randomized order
- Pre-specified 5% non-inferiority margin
- Two independent readers
Primary result
As reported in the abstract
Per-vessel diagnostic accuracy for significant CAD
Difference in diagnostic accuracy
+0.7%
CI −2.7% to 4.0%P for non-inferiority = 0.001
first reader
Difference in diagnostic accuracy
+3.4%
CI −0.1% to 6.8%P for non-inferiority < 0.001
second reader
Further findings
| Outcome | Accelerated CMR | Difference (min) (95% CI) | P value | |
|---|---|---|---|---|
| Scan durationShorter with accelerated CMR | mean 19 (SD 5) min | 24 (23–25) | P < 0.001 | |
| −100102030Difference, min (linear scale) |
| Outcome | Accelerated CMR | Difference in diagnostic accuracy (CI) | P value |
|---|---|---|---|
| Per-patient diagnostic accuracy (consensus read)Consensus read · secondary per-patient analysis | +4.6% (−1.5% to 11.0%) | P = 0.189 | |
| Accuracy | 88.6% | ||
| Sensitivity | 84.2% | ||
| Specificity | 93.2% |
Scan duration
- The accelerated scan was better tolerated by patients
Original publication
Accelerated stress CMR for the detection of significant coronary artery disease: a prospective randomized diagnostic accuracy study. Eur Heart J Cardiovasc Imaging. Published 20 November 2025. doi:10.
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