Diagnostic Performance of Cardiac Stress Perfusion MRI in the Detection of Coronary Artery Disease Using Fractional Flow Reserve as the Reference Standard: A Meta-Analysis

Abstract

OBJECTIVE. This is an analysis of pooled studies for the determination of the test characteristics of stress perfusion cardiac MRI in the diagnosis of flow-limiting obstructive coronary artery disease (CAD) using fractional flow reserve (FFR) at catheter coronary angiography as the reference standard. MATERIALS AND METHODS. Traditionally, planimetric measurement of coronary stenosis at catheter coronary angiography has been considered the reference standard and has been used to verify the diagnostic characteristics of gatekeeper tests. FFR is a physiologic measure of flow limitation and is considered a more authentic reference standard in the diagnosis of CAD. The emergence of a new reference standard questions the true diagnostic accuracy of gatekeeper tests. A systematic literature review was performed for qualifying studies. The DerSimonian-Laird random effects model and a random-effects symmetric summary receiver operating characteristic curve analysis were performed. RESULTS. Twelve studies (761 patients) met the inclusion criteria. Four hundred six stenotic coronary arteries had FFR less than 0.75. Perfusion stress MRI has a sensitivity of 89.1% (95% CI, 84-93%) and specificity of 84.9% (95% CI, 76.6-91.1%) on a patient basis and a sensitivity of 87.7% (95% CI, 84.4-90.6%) and specificity of 88.6% (95% CI, 86.7-90.4%) on a coronary territory basis. CONCLUSION. Stress perfusion MRI remains an accurate test for the detection of flow-limiting stenosis when adjudicated by a physiologic reference standard.

Cardiac Magnetic Resonance Performs Better in the Detection of Functionally Significant Coronary Artery Stenosis Compared to Single-Photon Emission Computed Tomography and Dobutamine Stress Echocardiography

“…These results are in agreement with a recent meta-analysis of 761 patients from 24 studies, which noted good diagnostic performance of 1.5-T and 3-T CMR-MPI in the detection of functionally significant CAD using an FFR cut-off f 0.75 as the reference standard. 19 We used 3-T CMR in this study. It had several potential advantages such as increased signal-to-noise and contrast-tonoise ratios.…”

Impact of fractional flow reserve on decision-making in daily clinical practice: A single center experience in Egypt

“…Fractional flow reserve (FFR) is currently considered the gold standard for assessment of functional significance of coronary stenosis and the expected benefit from revascularization 1, 2. The FFR provides a well-defined cut-off value for deciding whether to revascularize immediately or to defer intervention.…”

Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

“…In many of these studies, when FFR was not or could not be measured, values were assigned to vessels, and accordingly to vascular perfusion territories, on the basis of the angiographic findings. For example, in a recent metaanalysis of 12 studies reporting the diagnostic performance of CMR in stable CAD using FFR as the reference standard, on a coronary territory basis, pooled sensitivity was 88 % and pooled specificity was 89 %, suggesting high diagnostic accuracy of CMR for detection of flow-limiting stenosis [47]. Among the studies, however, the rate of actual FFR measurements in vessels included in analysis varied from 12 % to 100 %, with fewer than 75 % of vessels undergoing direct FFR interrogation in 10 of the studies [47][48][49].…”

“…For example, in a recent metaanalysis of 12 studies reporting the diagnostic performance of CMR in stable CAD using FFR as the reference standard, on a coronary territory basis, pooled sensitivity was 88 % and pooled specificity was 89 %, suggesting high diagnostic accuracy of CMR for detection of flow-limiting stenosis [47]. Among the studies, however, the rate of actual FFR measurements in vessels included in analysis varied from 12 % to 100 %, with fewer than 75 % of vessels undergoing direct FFR interrogation in 10 of the studies [47][48][49]. This may lead to significant error, since it is well known that patients with< 50 % stenosis on ICA may have functionally significant stenosis (FFR≤0.80) [50], and that patients with stenosis severity>50 %, or even>70 %, often have FFR values>0.80 [2,3].…”