Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease
- PMID: 39297850
- DOI: 10.1016/j.jcmg.2024.07.023
Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease
Abstract
Background: Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) using stress cardiovascular magnetic resonance (CMR) have been shown to identify epicardial coronary artery disease. However, comparative analysis between quantitative perfusion and conventional qualitative assessment (QA) remains limited.
Objectives: The aim of this multicenter study was to test the hypothesis that quantitative stress MBF (sMBF) and MPR analysis can identify obstructive coronary artery disease (obCAD) with comparable performance as QA of stress CMR performed by experienced physicians in interpretation.
Methods: The analysis included 127 individuals (mean age 62 ± 16 years, 84 men [67%]) who underwent stress CMR. obCAD was defined as the presence of stenosis ≥50% in the left main coronary artery or ≥70% in a major vessel. Each patient, coronary territory, and myocardial segment was categorized as having either obCAD or no obCAD (noCAD). Global, per coronary territory, and segmental MBF and MPR values were calculated. QA was performed by 4 CMR experts.
Results: At the patient level, global sMBF and MPR were significantly lower in subjects with obCAD than in those with noCAD, with median values of sMBF of 1.5 mL/g/min (Q1-Q3: 1.2-1.8 mL/g/min) vs 2.4 mL/g/min (Q1-Q3: 2.1-2.7 mL/g/min) (P < 0.001) and median values of MPR of 1.3 (Q1-Q3: 1.0-1.6) vs 2.1 (Q1-Q3: 1.6-2.7) (P < 0.001). At the coronary artery level, sMBF and MPR were also significantly lower in vessels with obCAD compared with those with noCAD. Global sMBF and MPR had areas under the curve (AUCs) of 0.90 (95% CI: 0.84-0.96) and 0.86 (95% CI: 0.80-0.93). The AUCs for QA by 4 physicians ranged between 0.69 and 0.88. The AUC for global sMBF and MPR was significantly better than the average AUC for QA.
Conclusions: This study demonstrates that sMBF and MPR using dual-sequence stress CMR can identify obCAD more accurately than qualitative analysis by experienced CMR readers.
Keywords: obstructive coronary artery disease; quantitative perfusion; stress cardiovascular magnetic resonance.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures Dr Ng has received educational funding from GE HealthCare, Bayer, Lode, TeraRecon, and Circle CVI; and is on the Speakers Bureau for Circle CVI, GE HealthCare, Bayer, and Boehringer Ingelheim. Dr Singh has received a startup grant from the Society for Cardiovascular Magnetic Resonance that helped fund an early phase of this study. Dr Pazhenkottil has received research funding from the Swiss Heart Foundation. Dr A.R. Patel has received research funding from GE HealthCare; and has received research support from Circle Cardiovascular Imaging, NeoSOFT, and Siemens Healthineers. Dr H. Patel has received funding from a T32 Cardiovascular Sciences Training Grant (5T32HL7381). Drs Wang and Janich are employees of GE HealthCare. Dr Amir-Khalili is an employee of Circle CVI. Dr Benovoy is a former employee of Circle CVI. Dr Friedrich is a shareholder and consultant of Area19 Medical and Circle CVI. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
