Results from new research (Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 or CE-MARC 2) into diagnostic procedures for those with angina pectoris, could soon change the diagnosis and management of this disease.
Angina pectoris is a heart condition marked by obstructions that cause narrowing or blocking in the arteries, resulting in pain or a feeling of congestion in the heart. It can also be a precursor to coronary heart disease.
The randomized trial included 1200 patients with suspected angina pectoris. Researchers found that using CMR (cardiovascular magnetic resonance) or MPS (myocardial perfusion scintigraphy)-guided care may be a faster and more accurate procedure for diagnosing angina pectoris than those recommended in the National Institute for Health and Care Excellence (NICE) guidelines.
CMR uses magnetic resonance imaging to assess the condition and functionality of the heart, while MPS relies on a radioactive tracer to evaluate the cardiovascular system. Of the two, the use of MPS is more widespread. NICE guidelines require a longer, more structured and systematic approach to diagnosing angina pectoris, and this new study is drawing that long process’ effectiveness into question.
A CMR procedure offers imaging for doctors to assess the functionality of the heart.
Those who underwent either CMR or MPS procedures during the twelve-month study saw a statistically significant reduction in the need for an unnecessary angiography when compared to the NICE patients, something that the lead researcher, Dr. John P. Greenwood, PhD, had identified as a key concern at the start of the program. Among the findings:
• Of those treated under the NICE guidelines, almost half needed to have an angiography, a quarter of which turned out to be unnecessary
• Less than 18 percent of the CMR patients required an angiography, with only 7.5 percent being unnecessary
• Less than 17 percent of the MPS patients needed one, with about 7 percent being unnecessary
Angiography is an invasive procedure, relying on a catheter inserted at the groin and pushed through the artery while being monitored by X-rays. Viable procedures that reduce or eliminate unnecessary invasive procedures are considered an important breakthrough in angina pectoris diagnosis methods.
While the study did have some limitations (narrow subject group, not addressing the impact of false positive and negative results), the general results of the research give strong support for widespread adoption of these imaging procedures for angina diagnosis. Early and accurate detection allows for a more rapid response in treatment and better management of the disease.