Evidence map›Paper›PMID 40962180›Full record

Trial reportJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance2025

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

Giandomenico Bisaccia, Peter P Swoboda, John F Younger, Neil Maredia, Catherine J Dickinson, Julia M Brown, Chiara Bucciarelli-Ducci, Sven Plein, John P Greenwood

Abstract readComparative StudyRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Giandomenico BisacciaRoyal Brompton and Harefield Hospitals, Guys' & St Thomas' NHS Trust, London, UK; Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Peter P SwobodaLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
John F YoungerRoyal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia.
Neil MarediaJames Cook University Hospital, Middlesbrough, UK.
Catherine J DickinsonDepartment of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Julia M BrownLeeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
Chiara Bucciarelli-DucciRoyal Brompton and Harefield Hospitals, Guys' & St Thomas' NHS Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College University, London, UK.
Sven PleinLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
John P GreenwoodLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Baker Heart and Diabetes Institute and Monash University, Melbourne, Australia. Electronic address: John.greenwood@baker.edu.au.

Funding

British Heart Foundation RG/05/004
6 · The paper itself

Abstract

backgroundExercise 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.

methodsPatients 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.

resultsOf 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.

conclusionIn 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.

Indexed as

Angina, StableElectrocardiographyExercise TestMagnetic Resonance Imaging, CineMyocardial Perfusion ImagingTomography, Emission-Computed, Single-PhotonAgedArea Under CurveCoronary AngiographyFemaleHumansMaleMiddle AgedPredictive Value of TestsPrognosisProspective StudiesAngina, stableDiagnostic techniques, cardiovascularExercise testMagnetic resonance imagingPrognosisRadionuclide imaging

Identifiers

PMID40962180
PMCPMC12745148

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.