AUTO-CMRA: Automated Coronary Magnetic Resonance Angiography for the Detection of Coronary Artery Stenosis
Study Details
Study Description
Brief Summary
Ischaemic Heart Disease (IHD) is the worlds leading cause of death. IHD is often caused by a narrowing of the coronary arteries, which prevents blood from flowing to the heart muscle, causing pain and damage to the heart. If an individual has a myocardial infarction (MI), parts of the heart that are damaged cannot be repaired. Therefore, it is important to identify and treat the narrowing of the arteries before an MI occurs.
At present there are 2 main methods of identifying narrowing of the arteries. The first is an invasive procedure, the other using a CT scan. Whilst both methods are effective, they entail risk. The invasive procedure can damage the coronary arteries, whilst the CT scan exposes patients to radiation and contrast, which can increase the risk of cancer and allergic reactions.
Magnetic Resonance (MR) scanning is an alternative to these methods, but it has been limited in use in the past due, in part, to the high technical knowledge required to obtain images. In addition, there is a degree of subjectivity in the selection of the mid-diastolic rest period, potentially affecting consistency of results. This means it is difficult to use in a day-to-day hospital environment. However, recent technological developments using artificial intelligence mean that images can be acquired in a more automated and consistent fashion. This new scan has yet to be tested in a clinical trial.
Therefore, the objective of the clinical study is to test this new scan to determine its efficacy. 160 patients at 5 sites at risk of coronary artery disease, who have been referred for a CT scan, will undergo both their CT scan and the new MR scan. The MR scan will then be compared to the CT scan for diagnostic accuracy and image quality.
The investigators hypothesise that the new MR scan will have the same diagnostic accuracy as the CT scan, with no differences in interpretation of the images across the 5 different hospitals.
If proven effective, this would demonstrate that MR scanning of the coronary arteries could prove a safe, clinically useful alternative to CT scanning and invasive assessment of coronary artery narrowing. In addition, if there is no difference across different locations, it would demonstrate that these scans can be performed consistently, facilitating implementation on a healthcare-system wide basis.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Patient Group A single cohort consisting of 160 patients referred for Coronary CT Angiography (CCTA) at risk of coronary artery disease. All patients will undergo both CCTA and CMRA |
Diagnostic Test: Coronary Magnetic Resonance Angiography (CMRA)
A novel automated CMRA protocol for detection of coronary artery stenosis
|
Outcome Measures
Primary Outcome Measures
- Haemodynamically significant CAD [CCTA will take place on clinical indication to investigate risk of CAD following an episode of chest pain. CMRA will be acquired ± 2 weeks compared to CCTA.]
Number of patients with haemodynamically significant CAD, defined as coronary artery diameter stenosis ≥50%, as assessed by CMRA, compared to CCTA.
Secondary Outcome Measures
- Image quality [CCTA will take place on clinical indication to investigate risk of CAD following an episode of chest pain. CMRA will be acquired ± 2 weeks compared to CCTA.]
Qualitative assessment of the image quality of the CMRA images. The scale used will be: 0, non-diagnostic; 1, poor (limited coronary vessel visibility or noisy image); 2, average (coronary vessel visible but diagnostic confidence low); 3, good (coronary artery adequately visualised and diagnostic quality image); and 4, excellent (coronary artery clearly depicted).
Other Outcome Measures
- Inter-reader variability in interpretation of the CMRA protocol [CCTA will take place on clinical indication to investigate risk of CAD following an episode of chest pain. CMRA will be acquired ± 2 weeks compared to CCTA.]
Number of patients with haemodynamically significant CAD, defined as coronary artery diameter stenosis ≥50%, as assessed by CMRA, as compared between different investigators at different sites in the multi-centre study.
- Pulse rate [CCTA will take place on clinical indication to investigate risk of CAD following an episode of chest pain. CMRA will be acquired ± 2 weeks compared to CCTA.]
Pulse during CMRA scan acquisition and association with image quality metrics
Eligibility Criteria
Criteria
Inclusion Criteria:
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Inclusion Criteria:
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≥18 years old
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Subject has provided informed written consent
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BMI < 35
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Sinus Rhythm
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Stable symptom at time of inclusion
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Scheduled to undergo elective CCTA within 14 days
Exclusion Criteria:
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Any contraindication to CMR
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Previous coronary revascularisation
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Inability to take sublingual nitroglycerin
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Irregular heart rate
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Contraindication to beta blockers
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Aarhus University Hospital | Aarhus | Denmark | 8200 |
Sponsors and Collaborators
- Aarhus University Hospital
Investigators
- Study Chair: Won Yong Kim, Department of Cardiology, Aarhus University Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- AUTO-CMRA