Validation of Dynamic 3-Dimensional Whole Heart Magnetic Resonance Myocardial Perfusion Imaging Against Fractional Flow Reserve for the Detection of Significant Coronary Artery Disease

被引:95
作者
Jogiya, Roy [4 ]
Kozerke, Sebastian [4 ,5 ,6 ]
Morton, Geraint [4 ]
De Silva, Kalpa [3 ]
Redwood, Simon [3 ]
Perera, Divaka [3 ]
Nagel, Eike [4 ]
Plein, Sven [1 ,2 ,4 ]
机构
[1] Univ Leeds, Leeds Gen Infirm, Multidisciplinary Cardiovasc Res Ctr, Leeds LS1 3EX, W Yorkshire, England
[2] Univ Leeds, Leeds Inst Genet Hlth & Therapeut, Leeds LS1 3EX, W Yorkshire, England
[3] Kings Coll London, BHF Ctr Excellence, NIHR Biomed Res Ctr,Rayne Inst, Guys & St Thomas NHS Fdn Trust,Cardiovasc Div, London WC2R 2LS, England
[4] Guys & St Thomas NHS Fdn Trust, Welcome Trust & EPSRC Med Engn Ctr, Div Imaging Sci, Rayne Inst, London, England
[5] Univ Zurich, Inst Biomed Engn, Zurich, Switzerland
[6] ETH, Zurich, Switzerland
基金
瑞士国家科学基金会;
关键词
cardiovascular magnetic resonance imaging; fractional flow reserve; myocardial perfusion; EMISSION COMPUTED-TOMOGRAPHY; PRINCIPAL COMPONENT ANALYSIS; CARDIAC-CATHETERIZATION; DIAGNOSTIC PERFORMANCE; STRESS PERFUSION; PROGNOSTIC VALUE; MEDICAL THERAPY; INTERVENTION; REVASCULARIZATION; METAANALYSIS;
D O I
10.1016/j.jacc.2012.02.075
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The goal of this study was to determine the diagnostic accuracy of dynamic 3-dimensional (3D) whole heart myocardial perfusion cardiovascular magnetic resonance (CMR) against invasively determined fractional flow reserve (FFR) and to establish the correlation between myocardium at risk defined by using the invasive Duke Jeopardy Score (DJS) and noninvasive 3D whole heart myocardial perfusion CMR. Background 3D whole heart myocardial perfusion CMR overcomes the limited spatial coverage of conventional twodimensional perfusion CMR methods and allows estimation of the extent of ischemia. The method has shown good diagnostic accuracy for the detection of coronary artery disease (CAD) as defined by using quantitative coronary angiography. However, quantitative coronary angiography does not provide a functional assessment of CAD as available from pressure wire-derived FFR. In the catheter laboratory, the DJS can complement FFR to estimate the myocardium at risk. Methods Fifty-three patients referred for angiography underwent rest and adenosine stress 3D whole heart myocardial perfusion CMR at 3-T. Perfusion was scored visually on a patient and coronary territory basis, and ischemic burden was calculated by quantitative segmentation of the volume of hypoenhancement. FFR was measured in vessels with >= 50% severity stenosis and an FFR <0.75 considered as hemodynamically significant. The DJS was calculated from the coronary angiograms to quantify the myocardium at risk. Results FFR was measured in 64 of 159 coronary vessels, and 39 had an FFR < 0.75. Sensitivity, specificity, and diagnostic accuracy of CMR for the detection of significant CAD were 91%, 90%, and 91%, on a patient basis and 79%, 92%, and 88%, respectively, by coronary territory. There was a strong correlation between the DJS and ischemic burden on CMR (p < 0.0001; Pearson's r = 0.82). Conclusions 3D whole heart myocardial perfusion CMR accurately detects functionally significant CAD as defined by using FFR and provides an assessment of ischemic burden in agreement with the invasive DJS. The accurate detection of significant CAD combined with an estimation of ischemic burden by using 3D myocardial perfusion CMR holds promise for noninvasive guidance of therapy and risk stratification of patients with CAD. (J Am Coll Cardiol 2012; 60: 756-65) (C) 2012 by the American College of Cardiology Foundation
引用
收藏
页码:756 / 765
页数:10
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