Abstract
Objectives: The purpose of this paper was to compare quantitative cardiac magnetic resonance (CMR) first-pass contrast-enhanced perfusion imaging to qualitative interpretation for determining the presence and severity of coronary artery disease (CAD). Background: Adenosine CMR can detect CAD by measuring perfusion reserve (PR) or by qualitative interpretation (QI). Methods: Forty-one patients with an abnormal nuclear stress scheduled for X-ray angiography underwent dual-bolus adenosine CMR. Segmental myocardial perfusion analyzed using both QI and PR by Fermi function deconvolution was compared to quantitative coronary angiography. Results: In the 30 patients with complete quantitative data, PR (mean ± SD) decreased stepwise as coronary artery stenosis (CAS) severity increased: 2.42 ± 0.94 for <50%, 2.14 ± 0.87 for 50% to 70%, and 1.85 ± 0.77 for >70% (p < 0.001). The PR and QI had similar diagnostic accuracies for detection of CAS >50% (83% vs. 80%), and CAS >70% (77% vs. 67%). Agreement between observers was higher for quantitative analysis than for qualitative analysis. Using PR, patients with triple-vessel CAD had a higher burden of detectable ischemia than patients with single-vessel CAD (60% vs. 25%; p = 0.02), whereas no difference was detected by QI (31% vs. 21%; p = 0.26). In segments with myocardial scar (n = 64), PR was 3.10 ± 1.34 for patients with CAS <50% (n = 18) and 1.91 ± 0.96 for CAS >50% (p < 0.0001). Conclusions: Quantitative PR by CMR differentiates moderate from severe stenoses in patients with known or suspected CAD. The PR analysis differentiates triple- from single-vessel CAD, whereas QI does not, and determines the severity of CAS subtending myocardial scar. This has important implications for assessment of prognosis and therapeutic decision making.
Original language | English (US) |
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Pages (from-to) | 561-569 |
Number of pages | 9 |
Journal | Journal of the American College of Cardiology |
Volume | 56 |
Issue number | 7 |
DOIs | |
State | Published - Aug 10 2010 |
Keywords
- AIF
- CAD
- CAS
- CMR
- ENDO/EPI
- GRE-EPI
- Gd-DTPA
- PR
- QI
- TE
- TF
- TI
- TR
- arterial input function
- cardiac magnetic resonance
- coronary artery disease
- coronary artery stenosis
- echo time
- endocardial to epicardial blood flow ratio
- gadolinium-diethylenetriamine penta-acetic acid
- hybrid gradient echo/echo planar imaging
- inversion time
- perfusion reserve
- qualitative interpretation
- repetition time
- tissue function
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine