Cardiac magnetic resonance myocardial perfusion imaging for detection of functionally significant obstructive coronary artery disease: A prospective study

Bettencourt, Nuno; Chiribiri, Amedeo; Schuster, Andreas; Ferreira, Nuno; Sampaio, Francisco; Duarte, Ricardo; Santos, Lino; Melica, Bruno; Rodrigues, Alberto; Braga, Pedro; Teixeira, Madalena; Simões, Lino; Leite‐Moreira, Adelino F.; Silva-Cardoso, José; Nagel, Eike; Portugal, Pedro; Gama, Vasco

doi:10.1016/j.ijcard.2012.09.231

Cited by 41 publications

(34 citation statements)

References 28 publications

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“…In accordance with previous studies,1, 2, 3, 4, 5, 6, 7 the results in our current study demonstrated that stress‐rest perfusion CMR allows for noninvasive prediction of flow‐limiting stenosis in patients with suspected or known CAD. However, we found that the assessment of stress‐rest perfusion CMR alone showed limited diagnostic concordance in predicting reduced FFR in multivessel disease.…”

Section: Discussionsupporting

confidence: 92%

Combined Assessment of Stress Myocardial Perfusion Cardiovascular Magnetic Resonance and Flow Measurement in the Coronary Sinus Improves Prediction of Functionally Significant Coronary Stenosis Determined by Fractional Flow Reserve in Multivessel Disease

Nakamori

Sakuma

Dohi

et al. 2018

JAHA

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BackgroundRecent studies using stress‐rest perfusion cardiovascular magnetic resonance (CMR) demonstrated a close correlation between myocardial ischemia and reduced fractional flow reserve (FFR). However, its diagnostic concordance may be reduced in patients with multivessel disease. We sought to evaluate the concordance of adenosine stress‐rest perfusion CMR for predicting reduced FFR, and to determine the additive value of measuring global coronary flow reserve (CFR) in the coronary sinus in multivessel disease.Methods and ResultsNinety‐six patients with angiographic luminal narrowing >50% underwent comprehensive CMR study and FFR measurements in 139 coronary vessels. FFR <0.80 was considered hemodynamically significant. Global CFR was quantified as the ratio of stress‐rest coronary sinus flow measured by phase‐contrast cine CMR. In 25 patients with single‐vessel disease, visual assessment of perfusion CMR yielded high diagnostic concordance for predicting flow‐limiting stenosis, with the area under receiver operating characteristic curve of 0.93 on a per‐patient basis. However, in 71 patients with multivessel disease, perfusion CMR underestimated flow‐limiting stenosis, resulting in the reduced area under receiver operating characteristic curve of 0.74. When CFR of <2.0 measured in the coronary sinus was considered as global myocardial ischemia, combined assessment provided correct reclassifications in 7 patients with false‐negative myocardial ischemia, and improved the diagnostic concordance to 92% sensitivity and 73% specificity with the area under receiver operating characteristic curve of 0.88 (95% confidence interval, 0.80%–0.97%, P=0.002).ConclusionsVisual analysis of stress‐rest perfusion CMR has limited concordance with FFR in patients with multivessel disease. Multiparametric CMR integrating stress‐rest perfusion CMR and flow measurement in the coronary sinus is useful for detecting reduced FFR in multivessel disease.

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Section: Discussionsupporting

confidence: 92%

Combined Assessment of Stress Myocardial Perfusion Cardiovascular Magnetic Resonance and Flow Measurement in the Coronary Sinus Improves Prediction of Functionally Significant Coronary Stenosis Determined by Fractional Flow Reserve in Multivessel Disease

Nakamori

Sakuma

Dohi

et al. 2018

JAHA

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“…18,21,22 Moreover, recent evidence demonstrates that FFR has a continuous and independent relationship with subsequent major adverse cardiac events and lower FFR values benefit more from revascularization. 23 However, there is an ongoing discussion on the true reference standard for the measurement of myocardial ischemia. Although this problem remains unresolved, an answer will be provided by outcome data as obtained in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial (ClinicalTrials.gov Identifier: NCT01471522).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Stress Myocardial Perfusion Imaging Compared to Invasive Coronary Angiography With Fractional Flow Reserve Meta-Analysis

Takx

Blomberg

Aidi

et al. 2015

Circ: Cardiovascular Imaging

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Background— Hemodynamically significant coronary artery disease is an important indication for revascularization. Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating hemodynamically significant coronary artery disease. The aim was to determine the diagnostic accuracy of myocardial perfusion imaging by single-photon emission computed tomography, echocardiography, MRI, positron emission tomography, and computed tomography compared with invasive coronary angiography with fractional flow reserve for the diagnosis of hemodynamically significant coronary artery disease. Methods and Results— The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. PubMed, EMBASE, and Web of Science were searched until May 2014. Thirty-seven studies, reporting on 4721 vessels and 2048 patients, were included. Meta-analysis yielded pooled sensitivity, pooled specificity, pooled likelihood ratios (LR), pooled diagnostic odds ratio, and summary area under the receiver operating characteristic curve. The negative LR (NLR) was chosen as the primary outcome. At the vessel level, MRI (pooled NLR, 0.16; 95% confidence interval [CI], 0.13–0.21) was performed similar to computed tomography (pooled NLR, 0.22; 95% CI, 0.12–0.39) and positron emission tomography (pooled NLR, 0.15; 95% CI, 0.05–0.44), and better than single-photon emission computed tomography (pooled NLR, 0.47; 95% CI, 0.37–0.59). At the patient level, MRI (pooled NLR, 0.14; 95% CI, 0.10–0.18) performed similar to computed tomography (pooled NLR, 0.12; 95% CI, 0.04–0.33) and positron emission tomography (pooled NLR, 0.14; 95% CI, 0.02–0.87), and better than single-photon emission computed tomography (pooled NLR, 0.39; 95% CI, 0.27–0.55) and echocardiography (pooled NLR, 0.42; 95% CI, 0.30–0.59). Conclusions— Stress myocardial perfusion imaging with MRI, computed tomography, or positron emission tomography can accurately rule out hemodynamically significant coronary artery disease and can act as a gatekeeper for invasive revascularization. Single-photon emission computed tomography and echocardiography are less suited for this purpose.

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“…Compared to SPECT, there are important advantages of APMR: superior diagnostic accuracy, lack of radiation, and higher spatial resolution, enabling detection of subendocardial perfusion defects [5,27]. Compared to FFR, APMR has an excellent diagnostic accuracy [6,28]. However, the (patho)physiological processes underlying CCO and APMR are different.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic significance of coronary stenosis by vessel attenuation measurement on CT compared with adenosine perfusion MRI

Dekker

Pelgrim

Pundziūtė

et al. 2015

European Journal of Radiology

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Cardiac magnetic resonance myocardial perfusion imaging for detection of functionally significant obstructive coronary artery disease: A prospective study

Cited by 41 publications

References 28 publications

Combined Assessment of Stress Myocardial Perfusion Cardiovascular Magnetic Resonance and Flow Measurement in the Coronary Sinus Improves Prediction of Functionally Significant Coronary Stenosis Determined by Fractional Flow Reserve in Multivessel Disease

Combined Assessment of Stress Myocardial Perfusion Cardiovascular Magnetic Resonance and Flow Measurement in the Coronary Sinus Improves Prediction of Functionally Significant Coronary Stenosis Determined by Fractional Flow Reserve in Multivessel Disease

Diagnostic Accuracy of Stress Myocardial Perfusion Imaging Compared to Invasive Coronary Angiography With Fractional Flow Reserve Meta-Analysis

Hemodynamic significance of coronary stenosis by vessel attenuation measurement on CT compared with adenosine perfusion MRI

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