iNav-based, Automated Coronary Magnetic Resonance Angiography for the Detection of Coronary Artery Stenosis (iNav-AUTO CMRA).

BACKGROUND

Coronary computed tomography angiography (CCTA) is recommended as the first line diagnostic imaging modality in low to intermediate risk individuals suspected of stable coronary artery disease (CAD). However, CCTA exposes patients to ionising radiation and potentially nephrotoxic contrast agents. Invasive coronary angiography (ICA) is the gold-standard investigation to guide coronary revascularisation strategy, however, invasive procedures incur an inherent risk to the patient. Coronary magnetic resonance angiography (Coronary MRA) avoids these issues. Nevertheless, clinical implementation is currently limited due to extended scanning durations, inconsistent image quality, and consequent lack of diagnostic accuracy. Several technical Coronary MRA innovations including advanced respiratory motion correction with 100% scan efficiency (no data rejection), fast image acquisition with motion-corrected undersampled image reconstruction and deep-learning (DL)-based automated planning have been implemented and now await clinical validation in multi-centre trials.

METHODS

The objective of the iNav-AUTO CMRA prospective multi-centre study is to evaluate the diagnostic accuracy of a newly developed, state-of-the-art, standardised, and automated Coronary MRA framework compared to CCTA in 230 patients undergoing clinical investigation for CAD. The study protocol mandates the administration of oral beta-blockers to decrease heart rate to below 60bpm and the use of sublingual nitroglycerine spray to induce vasodilation. Additionally, the study incorporates the utilisation of standardised postprocessing with sliding-thin-slab multiplanar reformatting, in combination with evaluation of the source images, to optimize the visualisation of coronary artery stenosis.

DISCUSSION

If proven effective, Coronary MRA could provide a non-invasive, needle-free, yet also clinically viable, alternative to CCTA.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov (NCT05473117).

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Competing interests KK is employed by Siemens Healthcare Limited, Camberley, UK. JW is employed by Siemens Healthcare GmbH, Erlangen, Germany. MM is supported by a grant from the Novo Nordisk Foundation (grant number NNF22OC0074083); has received lecture and/or advisory board fees from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, and Novo Nordisk, has received a travel grant from Novo Nordisk, has received institutional research grants from Philips, Bayer and Novo Nordisk, has ongoing research contracts with Janssen, Novo Nordisk, and Philips, and is a minor shareholder in Novo Nordisk, Eli Lilly & Company, and Verve Therapeutics.