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Research Article | Open Access

Accurate diagnosis of severe coronary stenosis based on resting magnetocardiography: a prospective, single-center, cross-sectional analysis

Jian-Guo CUI1,2, Feng TIAN2, Yu-Hao MIAO2, Qin-Hua JIN2, Ya-Jun SHI2, Li LI3, Meng-Jun SHEN3, Xiao-Ming XIE4, Shu-Lin ZHANG4(), Yun-Dai CHEN1,2()
School of Medicine, Nankai University, Tianjin, China
Senior Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
Joint Laboratory of Bioimaging Technology and Applications, SAS-SIMIT & MEDI, Shanghai, China
Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai, China
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Abstract

OBJECTIVE

To evaluate the role of resting magnetocardiography in identifying severe coronary artery stenosis in patients with suspected coronary artery disease.

METHODS

A total of 513 patients with angina symptoms were included and divided into two groups based on the extent of coronary artery disease determined by angiography: the non-severe coronary stenosis group (< 70% stenosis) and the severe coronary stenosis group (≥ 70% stenosis). The diagnostic model was constructed using magnetic field map (MFM) parameters, either individually or in combination with clinical indicators. The performance of the models was evaluated using receiver operating characteristic curves, accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Calibration plots and decision curve analysis were performed to investigate the clinical utility and performance of the models, respectively.

RESULTS

In the severe coronary stenosis group, QR_MCTDd, S_MDp, and TT_MAC50 were significantly higher than those in the non-severe coronary stenosis group (10.46 ± 10.66 vs. 5.11 ± 6.07, P < 0.001; 7.2 ± 8.64 vs. 4.68 ± 6.95, P = 0.003; 0.32 ± 57.29 vs. 0.26 ± 57.29, P < 0.001). While, QR_MVamp, R_MA, and T_MA in the severe coronary stenosis group were lower (0.23 ± 0.16 vs. 0.28 ± 0.16, P < 0.001; 55.06 ± 48.68 vs. 59.24 ± 53.01, P < 0.001; 51.67 ± 39.32 vs. 60.45 ± 51.33, P < 0.001). Seven MFM parameters were integrated into the model, resulting in an area under the curve of 0.810 (95% CI: 0.765–0.855). The sensitivity, specificity, PPV, NPV, and accuracy were 71.7%, 80.4%, 93.3%, 42.8%, and 73.5%; respectively. The combined model exhibited an area under the curve of 0.845 (95% CI: 0.798–0.892). The sensitivity, specificity, PPV, NPV, and accuracy were 84.3%, 73.8%, 92.6%, 54.6%, and 82.1%; respectively. Calibration curves demonstrated excellent agreement between the nomogram prediction and actual observation. The decision curve analysis showed that the combined model provided greater net benefit compared to the magnetocardiography model.

CONCLUSIONS

The novel quantitative MFM parameters, whether used individually or in combination with clinical indicators, have been shown to effectively predict the risk of severe coronary stenosis in patients presenting with angina-like symptoms. Magnetocardiography, an emerging non-invasive diagnostic tool, warrants further exploration for its potential in diagnosing coronary heart disease.

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Journal of Geriatric Cardiology
Volume 21 Issue 4,
April 2024
Pages 407-420
DOI: 10.26599/1671-5411.2024.04.006
Cite this article:
CUI J-G, TIAN F, MIAO Y-H, et al. Accurate diagnosis of severe coronary stenosis based on resting magnetocardiography: a prospective, single-center, cross-sectional analysis. Journal of Geriatric Cardiology, 2024, 21(4): 407-420. https://doi.org/10.26599/1671-5411.2024.04.006
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Naming rules and meanings of magnetocardiography parameters.

Full nameAbbreviationDefinitionRelated parameters
Distribution of magnetic dipole center trajectoryMCTDdDistribution of magnetic dipole center trajectory in specific intervalQR_MCTDd, RS_MCTDd, QRS_MCTDd, TT_MCTDd
Magnetic pole vector based on amplitudeMVampVector value from positive to negative pole based on amplitude in specific intervalQR_MVamp, RS_MVamp, QRS_MVamp, TT_MVamp
Dispersion of magnetic poleMDpDispersion of magnetic pole morph at specific time point or intervalQ_MDp, R_MDp, S_MDp, T_MDp, QRS_MDp, TT_MDp
Magnetic pole angleMAAngle from positive to negative pole at specific time pointQ_MA, R_MA, S_MA, T_MA
Angle changes of magnetic poleMAC50Median of angle changes from positive to negative pole in specific intervalTT_MAC50

Demographic characteristics and clinical indicators of the study patients (n = 513).

VariablesThe nsCS group (n = 107)The sCS group (n = 406)P-value
Data are presented as means ± SD or n (%). *Presented as median (interquartile range). nsCS: non-severe coronary stenosis; sCS: severe coronary stenosis.
Age, yrs 60.7 ± 10.4 61.4 ± 9.8 0.409
Heart rate, beats/min 78.2 ± 10.2 78.1 ± 10.9 0.924
Body mass index, kg/m2 29.0 ± 36.7 25.7 ± 3.1 0.736
Male sex78 (72.9%)316 (77.8%)0.282
Typical symptoms93 (86.9%)372 (91.6%)0.137
Hypertension62 (57.9%)268 (66.0%)0.121
Type 2 diabetes mellitus25 (23.4%)145 (35.7%)0.016
Smoking36 (33.6%)151 (37.2%)0.498
Family history19 (17.8%)63 (15.5%)0.574
Total protein, g/L67.73 ± 4.87 68.43 ± 4.83 0.269
Serum albumin, g/L42.07 ± 3.13 41.93 ± 3.47 0.664
Myoglobin, ng/mL37.58 ± 72.3 37.69 ± 35.620.123
Creatine kinase-MB, U/L 1.43 ± 1.15 1.47 ± 1.03 0.533
B-type natriuretic peptide, pmol/L55.75 (18.15–95.55)*65.30 (25.20–145.10)*0.013
Total cholesterol, mmol/L 3.86 ± 1.05 3.7 ± 0.95 0.141
Triglycerides, mmol/L 1.54 ± 1.1 1.62 ± 0.93 0.17
Apoprotein A1, g/L1.361 ± 0.2871.255 ± 0.2240.002
Apoprotein B, g/L0.674 ± 0.1940.646 ± 0.1870.195
High-density lipoprotein, mmol/L 1.18 ± 0.32 1.08 ± 0.27 0.002
Low-density lipoprotein, mmol/L 2.27 ± 0.93 2.19 ± 0.86 0.464
Blood glucose, mmol/L 5.68 ± 1.58 5.84 ± 1.82 0.274
C-reactive protein, mg/dL 0.21 ± 0.4 0.25 ± 0.68 0.072
Interleukin 6, ng/L 2.98 ± 2.93 4.97 ± 14.730.052
Fibrinogen, g/L 3.02 ± 0.7 3.19 ± 0.72 0.012
D-dimer, μg/mL 0.24 ± 0.15 0.36 ± 0.62 < 0.001

Magnetocardiography parameters values of the nsCS group and the sCS group (n = 513).

ParametersThe nsCS group (n = 107)The sCS group (n = 406)P-value
Data are presented as means ± SD. nsCS: non-severe coronary stenosis; sCS: severe coronary stenosis.
QR_
　QR_MCTDd, %5.11 ± 6.0710.46 ± 10.66< 0.001
　QR_MVamp0.28 ± 0.160.23 ± 0.160.002
RS_
　RS_MCTDd, %6.54 ± 6.717.71 ± 6.830.065
　RS_MVamp0.24 ± 0.180.25 ± 0.180.475
QRS_
　QRS_MCTDd, %28.49 ± 9.9528.75 ± 9.060.635
　QRS_MDp13.9 ± 22.2318.19 ± 28.290.236
　QRS_MVamp0.43 ± 0.230.41 ± 0.230.333
TT_
　TT_MCTDd, %14.44 ± 11.416.14 ± 11.710.148
　TT__MDp12.01 ± 13.1111.66 ± 11.230.536
　TT_MVamp0.23 ± 0.140.23 ± 0.160.791
　TT_MAC500.26 ± 57.290.32 ± 57.29< 0.001
Q-wave
　Q_MDp5.44 ± 6.456.89 ± 9.230.474
　Q_MA290.9 ± 48.12296.43 ± 42.330.06
R-wave
　R_MDp4.96 ± 6.134.38 ± 4.910.719
　R_MA59.24 ± 53.0155.06 ± 48.68< 0.001
S-wave
　S_MDp4.68 ± 6.957.2 ± 8.640.003
　S_MA227.57 ± 42.1233.97 ± 28.85< 0.001
T-wave
　T_MDp4.93 ± 7.284.65 ± 6.380.857
　T_MA60.45 ± 51.3351.67 ± 39.32< 0.001

The effectiveness of magnetocardiography parameter and combined parameters in predictive diagnostic model for detection of coronary artery disease with above 70% stenosis.

ParametersReference rangeReceiver operating characteristic area (95% CI)CutoffSensitiveSpecificityPPVNPVDiagnostic accuracyP-value
*Refer to includ magnetocardiography parameters and type 2 diabetes mellitus. NPV: negative predictive value; PPV: positive predictive value.
Magnetocardiography parameters
　All magnetocardiography parameters–0.81 (0.765–0.855)0.76571.7%80.4%93.3%42.8%73.5%< 0.001
　QR_MCTDd–0.655 (0.601–0.709)0.74270% 53.3%85% 31.8%66.5%< 0.001
　QR_MVamp–0.597 (0.539–0.654)0.82334.2%85% 89.7%25.4%44.8%0.001
　S_MDp–0.591 (0.536–0.647)0.79344.3%76.6%87.8%26.6%51.1%0.001
　T_MA, degree−90 to −110.657 (0.624–0.690)0.83637.9%93.5%95.7%28.4%49.5%< 0.001
　R_MA, degree−79 to −210.594 (0.556–0.633)0.82831% 87.9%90.6%25.1%42.9%< 0.001
　S_MA, degree 48 to 1730.588 (0.546–0.631)0.81834.5%83.2%88.6%25.1%44.6%< 0.001
　TT_MAC50, degree0.1 to 0.20.512 (0.482–0.543)0.76693.1%9.3% 79.6%26.3%75.6%0.805
Combined parameters*
　Apoprotein A1–0.845 (0.798–0.892)0.71284.3%73.8%92.6%54.6%82.1%< 0.001
　D-dimer–0.824 (0.780–0.868)0.83664.1%85.7%94.5%38.5%68.6%< 0.001
　B-type natriuretic peptide–0.820 (0.774–0.865)0.79670.5%79.4%93% 40.9%72.3%< 0.001
　Fibrinogen–0.818 (0.773–0.863)0.68483.4%67.3%90.6%51.8%80% < 0.001

Multivariate binary logistic regression analysis results of magnetocardiography model and combined model.

ParametersβOR95% CIP-value
Magnetocardiography model
　Constant−0.780.460.15–1.360.16
　QR_MCTDd0.842.311.65–3.36< 0.001
　S_MDp0.041.041.01–1.080.03
　T_MA2.148.534.04–21.00< 0.001
　R_MA1.153.161.66–6.43< 0.001
　S_MA0.651.921.06–3.620.04
　QR_MVamp−0.360.690.15–3.410.65
　TT_MAC500.61.820.74–4.280.18
Combined model
　Constant1.715.500.84–37.910.08
　QR_MCTDd0.802.231.53–3.41< 0.001
　QR_MVamp−0.250.780.11–5.890.81
　S_MDp0.041.040.99–1.090.12
　T_MA, yes2.3210.204.19–30.84< 0.001
　R_MA, yes1.665.282.33–13.73< 0.001
　S_MA, yes0.611.850.92–3.890.09
　TT_MAC50, yes0.341.410.48–3.780.51
　Type 2 diabetes mellitus, yes0.782.181.14–4.350.02
　Apoprotein A1−1.930.150.04–0.460.001