Validation of Magnetic Resonance Myocardial Perfusion Imaging With Fractional Flow Reserve for the Detection of Significant Coronary Heart Disease

Abstract

Background-Magnetic resonance myocardial perfusion imaging (MRMPI) has a number of advantages over the other noninvasive tests used to detect reversible myocardial ischemia. The majority of previous studies have generally used quantitative coronary angiography as the gold standard to assess the accuracy of MRMPI; however, only an approximate relationship exists between stenosis severity and functional significance. Pressure wire-derived fractional flow reserve (FFR) values Ͻ0.75 correlate closely with objective evidence of reversible ischemia. Accordingly, we have compared MRMPI with FFR. Methods and Results-One hundred three patients referred for investigation of suspected angina underwent MRMPI with a 1.5-T scanner. The stress agent was intravenous adenosine (140 g · kg Ϫ1 · min Ϫ1 ), and the first-pass bolus contained 0.1 mmol/kg gadolinium. In the following week, coronary angiography with pressure wire studies was performed. FFR was recorded in all patent major epicardial coronary arteries, with a value Ͻ0.75 denoting significant stenosis. MRMPI scans, analyzed by 2 blinded observers, identified perfusion defects in 121 of 300 coronary artery segments (40%), of which 110 had an FFR Ͻ0.75. We also found that 168 of 179 normally perfused segments had an FFR Ն0.75. The sensitivity and specificity of MRMPI for the detection of functionally significant coronary heart disease were 91% and 94%, respectively, with positive and negative predictive values of 91% and 94%. Conclusion-MRMPI can detect functionally significant coronary heart disease with excellent sensitivity, specificity, and positive and negative predictive values compared with FFR. (Circulation. 2009;120:2207-2213.)

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

“…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.…”

Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

“…Coronary pressure-derived FFR is an invasive index used to identify stenosis responsible for reversible ischemia, and is well validated [21,27,28]. An FFR of 0.80 discriminates coronary stenosis responsible for ischemia with an accuracy >90% [29,30]. The FAME study reported favorable outcomes of FFR-guided PCI when compared with conventional angiography guided PCI [11,22].…”

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

“…An FFR value <0.80 identifies ischemia-causing coronary stenoses with an accuracy of >90%. 6,7 The recent remarkable development of multidetectorrow computed tomography has facilitated noninvasive assessments in outpatients with coronary artery disease (CAD), but techniques for the physiological assessment of ischemia (such as SPECT) are not often performed when patients undergo invasive CAG. FFR has been…”