Cologne (Germany): Institute for Quality and Efficiency in Health Care (IQWiG); 2026 Feb 22.
ABSTRACT
RESEARCH QUESTION: The aim of this report is to
assess the benefit of diagnostics using cardiac magnetic resonance imaging as part of a diagnostic strategy, compared with a diagnostic strategy without cardiac magnetic resonance imaging, in terms of patient-relevant outcomes. These diagnostics should be used as further diagnostics in patients who, following basic diagnostics, are suspected to have chronic coronary heart disease or progression of chronic coronary heart disease, in either case with moderate pretest probability (15% to 85%), and for whom a functional diagnostic technique is indicated.
CONCLUSION: In this assessment, as a first step, cardiac magnetic resonance imaging was investigated in comparison with other functional non-invasive diagnostic procedures (single photon emission computed tomography, stress echocardiography or exercise electrocardiography) on the basis of studies on the diagnostic-therapeutic treatment chain. One randomized controlled trial could be used for this purpose, namely on the comparison of cardiac magnetic resonance imaging with single photon emission computed tomography.
The study provided usable data for the outcomes all-cause mortality, cardiovascular mortality, unnecessary invasive diagnostics and health-related quality of life. For none of these patient-relevant outcomes was there an effect in favour or to the disadvantage of cardiac magnetic resonance imaging compared with single photon emission computed tomography, but the data situation was mostly insufficient due to the rarity of the events that occurred in these outcomes. Based on the randomized controlled trial, it was therefore not possible to derive a hint of (greater) benefit or harm of cardiac magnetic resonance imaging compared with single photon emission computed tomography.
Since no benefit conclusion could be derived for the diagnostic-therapeutic chain for the aforementioned comparison, in a 2nd step, cardiac magnetic resonance imaging was compared with single photon emission computed tomography on the basis of studies on diagnostic accuracy. For this comparison, 6 studies with usable results on diagnostic accuracy were used for the assessment. Studies on diagnostic accuracy comparing cardiac magnetic resonance imaging with stress echocardiography or exercise electrocardiography were not included because these 2 alternative functional diagnostic techniques were considered to be of less clinical importance.
An analysis of the results of test quality studies comparing cardiac magnetic resonance imaging with single photon emission computed tomography in terms of sensitivity and specificity resulted in at least comparable diagnostic accuracy. Cardiac magnetic resonance imaging also has the inherent advantage over single photon emission computed tomography that it is conducted without exposing patients to radiation. Overall, there is a hint of greater benefit of cardiac magnetic resonance imaging in comparison with single photon emission computed tomography.
Cardiac magnetic resonance imaging is therefore a suitable non-invasive diagnostic technique for patients with suspected coronary heart disease or suspected progression of known coronary heart disease for whom a functional diagnostic technique is indicated.