MRI is the best test for suspected heart disease, study says

By John Murphy, MDLinx
Published May 17, 2016

Key Takeaways

Magnetic resonance imaging (MRI) is better than computerized tomography (CT) for predicting major cardiovascular events in patients with suspected coronary heart disease, according to a 5-year follow-up study published May 10, 2016 in the journal Annals of Internal Medicine.

For this study, investigators compared cardiovascular magnetic resonance (CMR) to single-photon emission computed tomography (SPECT) in about 750 patients who had suspected stable angina and at least 1 major cardiovascular risk factor. The subjects underwent both CMR and SPECT, as well as X-ray angiography as a standard reference test.

During 5 years of annual follow-up, nearly 17% of subjects had at least 1 major adverse cardiac event, which included cardiovascular death, heart attack/acute coronary syndrome, unscheduled coronary revascularization, or hospital admission for any cardiovascular cause (such as stroke, transient ischemic attack, heart failure, or arrhythmia).

The researchers found that both CMR and SPECT strongly predicted major adverse cardiac events. However, after adjusting for other cardiovascular risk factors, angiography results, or stratification for initial patient treatment, only CMR remained a significant predictor.

“This research shows that MRI is the best noninvasive way to diagnose significant coronary heart disease in people with chest pain,” stated cardiologist Peter Weissberg, MD, Medical Director of the British Heart Foundation, which funded the study.

The researchers also pointed out that CMR doesn’t use ionizing radiation and can be performed in a single study.

However, “The benefits of cardiac MRI are not limited to reducing exposure to ionizing radiation,” said lead investigator John P. Greenwood, MBChB, PhD, Professor of Cardiology at the Leeds Institute of Cardiovascular and Metabolic Medicine, in Leeds, UK. “The non-invasive cardiac MRI test, which is not only more diagnostically accurate and cost effective for the National Health Service than SPECT, is also potentially better at forecasting the outcome of the disease.” 

“Although SPECT is currently more widely available than MRI, the use of MRI across a wide spectrum of diseases means that it will be much more readily available for heart disease investigation in coming years,” Dr. Greenwood added. “The outcomes of this study could lead to changes in clinical guidelines and to the way doctors investigate chest pain due to suspected heart disease."

The researchers acknowledged limitations to their investigation. For one, this was an observational study of two modalities in the same patient population, and not a randomized trial that directly compared both SPECT and CMR.

Nevertheless, this study demonstrated that CMR is certainly a worthwhile alternative to SPECT for diagnosing patients with suspected coronary heart disease, the researchers concluded.

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