TY - JOUR
T1 - Myocardial Blood Flow by Magnetic Resonance in Patients With Suspected Coronary Stenosis
T2 - Comparison to PET and Invasive Physiology
AU - Rasmussen, Laust Dupont
AU - Murphy, Theodore
AU - Milidonis, Xenios
AU - Eftekhari, Ashkan
AU - Karim, Salma Raghad
AU - Westra, Jelmer
AU - Dahl, Jonathan Nørtoft
AU - Isaksen, Christin
AU - Brix, Lau
AU - Ejlersen, June Anita
AU - Nyegaard, Mette
AU - Johansen, Jane Kirk
AU - Søndergaard, Hanne Maare
AU - Mortensen, Jesper
AU - Gormsen, Lars Christian
AU - Christiansen, Evald Høj
AU - Chiribiri, Amedeo
AU - Petersen, Steffen E
AU - Bøttcher, Morten
AU - Winther, Simon
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/6/18
Y1 - 2024/6/18
N2 - BACKGROUND: Despite recent guideline recommendations, quantitative perfusion (QP) estimates of myocardial blood flow from cardiac magnetic resonance (CMR) have only been sparsely validated. Furthermore, the additional diagnostic value of utilizing QP in addition to the traditional visual expert interpretation of stress-perfusion CMR remains unknown. The aim was to investigate the correlation between myocardial blood flow measurements estimated by CMR, positron emission tomography, and invasive coronary thermodilution. The second aim is to investigate the diagnostic performance of CMR-QP to identify obstructive coronary artery disease (CAD).METHODS: Prospectively enrolled symptomatic patients with >50% diameter stenosis on computed tomography angiography underwent dual-bolus CMR and positron emission tomography with rest and adenosine-stress myocardial blood flow measurements. Subsequently, an invasive coronary angiography (ICA) with fractional flow reserve and thermodilution-based coronary flow reserve was performed. Obstructive CAD was defined as both anatomically severe (>70% diameter stenosis on quantitative coronary angiography) or hemodynamically obstructive (ICA with fractional flow reserve ≤0.80).RESULTS: About 359 patients completed all investigations. Myocardial blood flow and reserve measurements correlated weakly between estimates from CMR-QP, positron emission tomography, and ICA-coronary flow reserve (r<0.40 for all comparisons). In the diagnosis of anatomically severe CAD, the interpretation of CMR-QP by an expert reader improved the sensitivity in comparison to visual analysis alone (82% versus 88% [
P=0.03]) without compromising specificity (77% versus 74% [
P=0.28]). In the diagnosis of hemodynamically obstructive CAD, the accuracy was only moderate for a visual expert read and remained unchanged when additional CMR-QP measurements were interpreted.
CONCLUSIONS: CMR-QP correlates weakly to myocardial blood flow measurements by other modalities but improves diagnosis of anatomically severe CAD.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481712.
AB - BACKGROUND: Despite recent guideline recommendations, quantitative perfusion (QP) estimates of myocardial blood flow from cardiac magnetic resonance (CMR) have only been sparsely validated. Furthermore, the additional diagnostic value of utilizing QP in addition to the traditional visual expert interpretation of stress-perfusion CMR remains unknown. The aim was to investigate the correlation between myocardial blood flow measurements estimated by CMR, positron emission tomography, and invasive coronary thermodilution. The second aim is to investigate the diagnostic performance of CMR-QP to identify obstructive coronary artery disease (CAD).METHODS: Prospectively enrolled symptomatic patients with >50% diameter stenosis on computed tomography angiography underwent dual-bolus CMR and positron emission tomography with rest and adenosine-stress myocardial blood flow measurements. Subsequently, an invasive coronary angiography (ICA) with fractional flow reserve and thermodilution-based coronary flow reserve was performed. Obstructive CAD was defined as both anatomically severe (>70% diameter stenosis on quantitative coronary angiography) or hemodynamically obstructive (ICA with fractional flow reserve ≤0.80).RESULTS: About 359 patients completed all investigations. Myocardial blood flow and reserve measurements correlated weakly between estimates from CMR-QP, positron emission tomography, and ICA-coronary flow reserve (r<0.40 for all comparisons). In the diagnosis of anatomically severe CAD, the interpretation of CMR-QP by an expert reader improved the sensitivity in comparison to visual analysis alone (82% versus 88% [
P=0.03]) without compromising specificity (77% versus 74% [
P=0.28]). In the diagnosis of hemodynamically obstructive CAD, the accuracy was only moderate for a visual expert read and remained unchanged when additional CMR-QP measurements were interpreted.
CONCLUSIONS: CMR-QP correlates weakly to myocardial blood flow measurements by other modalities but improves diagnosis of anatomically severe CAD.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481712.
KW - Aged
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Blood Flow Velocity
KW - Computed Tomography Angiography
KW - Coronary Angiography/methods
KW - Coronary Circulation/physiology
KW - Coronary Stenosis/physiopathology
KW - Coronary Vessels/physiopathology
KW - Fractional Flow Reserve, Myocardial/physiology
KW - Myocardial Perfusion Imaging/methods
KW - Positron-Emission Tomography/methods
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Reproducibility of Results
KW - Severity of Illness Index
KW - Thermodilution
UR - http://www.scopus.com/inward/record.url?scp=85196521437&partnerID=8YFLogxK
U2 - 10.1161/CIRCIMAGING.124.016635
DO - 10.1161/CIRCIMAGING.124.016635
M3 - Article
C2 - 38889213
AN - SCOPUS:85196521437
SN - 1941-9651
VL - 17
SP - 450
EP - 462
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 6
ER -
