Diagnostic performance of treadmill exercise cardiac magnetic resonance: the prospective, multicenter EXACT trial

Methods Patients clinically referred for treadmill stress SPECT for the evaluation of known or suspected CAD were prospectively enrolled across 4 centers. After rest Tc99m SPECT imaging, patients underwent resting cine CMR. In-room stress was then performed using an MR-compatible treadmill with continuous 12-lead ECG monitoring and the Bruce exercise protocol. At peak stress, Tc99m was injected and patients were rapidly returned to their prior position in the magnet for real-time, free-breathing post-exercise cine and perfusion CMR. Following recovery monitoring with the table brought outside of the magnet bore, recovery cine and rest perfusion followed by late gadolinium enhancement acquisitions concluded the CMR portion of the exam. Stress SPECT images were then acquired in the adjacent nuclear laboratory. Patients not referred for invasive coronary angiography (ICA) within 2 weeks of stress imaging underwent coronary angiography with computed tomography (CTA). Diagnostic accuracy and prognostic value of treadmill stress CMR vs. SPECT were evaluated.