Stress CMR VS Stress Echo: Real-world multimodal cardiovascular imaging for myocardial ischemia screening. Insights from the first phase of “Nancy Ischemia Registry”

In a real world, the impact of different functional and anatomical imaging techniques is not really known. Objectives “Nancy Ischemia Registry” is a prospective registry, without inclusion or exclusion criteria, which analyzes the respective real impact and consequences of different functional and anatomical imaging techniques on major adverse cardiovascular events. In a “first phase”, we compared two functional imaging techniques used in our center: Stress CMR and Stress Echo. Materials & Methods We consecutively included 169 patients in whom we performed Stress CMR and 687 patients in whom we performed Stress Echo. Results We detected myocardial ischemia in 59 patients by Stress CMR (35% of patients) and in 123 patients by Stress Echo (18% of patients). Coronary angiography confirmed at least one significant lesion in 54 patients in the Stress CMR group (PPV 91%) and in 90 patients in the Stress Echo group (PPV 73%). In patients with at least one significant coronary lesion, coronary angioplasty was performed in 38 patients (64% of true positives) in the Stress CMR group versus 64 patients in the Stress Echo group (71 % of true positives). Conclusion Stress CMR has a better specificity than Stress Echo for the detection of myocardial ischemia. However, detection of myocardial ischemia by Stress Echo more often leads to coronary revascularization than by Stress CMR. This difference in this register is probably explained by a higher sensitivity of the Stress CMR for the detection of myocardial ischemia linked to less severe lesions, whereas the Stress Echo mainly detects more severe lesions.