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J Am Coll Cardiol. 2010 Aug 10;56(7):561-9. doi: 10.1016/j.jacc.2010.02.061.

Assessment of advanced coronary artery disease: advantages of quantitative cardiac magnetic resonance perfusion analysis.

Author information

1
Department of Medicine, University of Chicago, Chicago, Illinois, USA.

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.

PMID:
20688211
PMCID:
PMC2930835
DOI:
10.1016/j.jacc.2010.02.061
[Indexed for MEDLINE]
Free PMC Article

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