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Gadobutrol-enhanced cardiac magnetic resonance imaging for detection of coronary artery disease

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Item Type:Article
Title:Gadobutrol-enhanced cardiac magnetic resonance imaging for detection of coronary artery disease
Creators Name:Arai, A.E. and Schulz-Menger, J. and Berman, D. and Mahrholdt, H. and Han, Y. and Bandettini, W.P. and Gutberlet, M. and Abraham, A. and Woodard, P.K. and Selvanayagam, J.B. and McCann, G.P. and Hamilton-Craig, C. and Schoepf, U.J. and Tan, R.S. and Kramer, C.M. and Friedrich, M.G. and Haverstock, D. and Liu, Z. and Brueggenwerth, G. and Bacher-Stier, C. and Santiuste, M. and Pennell, D.J.
Abstract:BACKGROUND: Gadolinium-based contrast agents were not approved in the United States for detecting coronary artery disease (CAD) prior to the current studies. OBJECTIVES: The purpose of this study was to determine the sensitivity and specificity of gadobutrol for detection of CAD by assessing myocardial perfusion and late gadolinium enhancement (LGE) imaging. METHODS: Two international, single-vendor, phase 3 clinical trials of near identical design, "GadaCAD1" and "GadaCAD2," were performed. Cardiovascular magnetic resonance (CMR) included gadobutrol-enhanced first-pass vasodilator stress and rest perfusion followed by LGE imaging. CAD was defined by quantitative coronary angiography (QCA) but computed tomography coronary angiography could exclude significant CAD. RESULTS: Because the design and results for GadaCAD1 (n = 376) and GadaCAD2 (n = 388) were very similar, results were summarized as a fixed-effect meta-analysis (n = 764). The prevalence of CAD was 27.8% defined by a ≥70% QCA stenosis. For detection of a ≥70% QCA stenosis, the sensitivity of CMR was 78.9%, specificity was 86.8%, and area under the curve was 0.871. The sensitivity and specificity for multivessel CAD was 87.4% and 73.0%. For detection of a 50% QCA stenosis, sensitivity was 64.6% and specificity was 86.6%. The optimal threshold for detecting CAD was a ≥67% QCA stenosis in GadaCAD1 and ≥63% QCA stenosis in GadaCAD2. CONCLUSIONS: Vasodilator stress and rest myocardial perfusion CMR and LGE imaging had high diagnostic accuracy for CAD in 2 phase 3 clinical trials. These findings supported the U.S. Food and Drug Administration approval of gadobutrol-enhanced CMR (0.1 mmol/kg) to assess myocardial perfusion and LGE in adult patients with known or suspected CAD.
Keywords:Coronary Artery Disease, CMR, Gadobutrol, Myocardial Infarction, Myocardial Perfusion
Source:Journal of the American College of Cardiology
Page Range:1536-1547
Date:29 September 2020
Official Publication:https://doi.org/10.1016/j.jacc.2020.07.060
PubMed:View item in PubMed

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