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Assessment of Multivessel Coronary Artery Disease Using Cardiovascular Magnetic Resonance Pixelwise Quantitative Perfusion Mapping
- Source :
- JACC. Cardiovascular imaging. 13(12)
- Publication Year :
- 2019
-
Abstract
- The authors sought to compare the diagnostic accuracy of quantitative perfusion maps to visual assessment (VA) of first-pass perfusion images for the detection of multivessel coronary artery disease (MVCAD).VA of first-pass stress perfusion cardiac magnetic resonance (CMR) may underestimate ischemia in MVCAD. Pixelwise perfusion mapping allows quantitative measurement of regional myocardial blood flow, which may improve ischemia detection in MVCAD.One hundred fifty-one subjects recruited at 2 centers underwent stress perfusion CMR with myocardial perfusion mapping, and invasive coronary angiography with coronary physiology assessment. Ischemic burden was assessed by VA of first-pass images and by quantitative measurement of stress myocardial blood flow using perfusion maps.In patients with MVCAD (2-vessel [2VD] or 3-vessel disease [3VD]; n = 95), perfusion mapping identified significantly more segments with perfusion defects (median segments per patient 12 [interquartile range (IQR): 9 to 16] by mapping vs. 8 [IQR: 5 to 9.5] by VA; p 0.001). Ischemic burden (IB) measured using mapping was higher in MVCAD compared with IB measured using VA (3VD mapping 100 % (75% to 100%) vs. first-pass 56% (38% to 81%) ; 2VD mapping 63% (50% to 75%) vs. first-pass 41% (31% to 50%); both p 0.001), but there was no difference in single-vessel disease (mapping 25% (13% to 44%) vs. 25% (13% to 31%). Perfusion mapping was superior to VA for the correct identification of extent of coronary disease (78% vs. 58%; p 0.001) due to better identification of 3VD (87% vs. 40%) and 2VD (71% vs. 48%).VA of first-pass stress perfusion underestimates ischemic burden in MVCAD. Pixelwise quantitative perfusion mapping increases the accuracy of CMR in correctly identifying extent of coronary disease. This has important implications for assessment of ischemia and therapeutic decision-making.
- Subjects :
- medicine.medical_specialty
Adenosine
Magnetic Resonance Spectroscopy
Ischemia
Coronary Artery Disease
030204 cardiovascular system & hematology
Coronary Angiography
Severity of Illness Index
030218 nuclear medicine & medical imaging
Quantitative perfusion
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Interquartile range
Predictive Value of Tests
Internal medicine
Coronary Circulation
medicine
Humans
Radiology, Nuclear Medicine and imaging
medicine.diagnostic_test
business.industry
Myocardial Perfusion Imaging
Magnetic resonance imaging
Blood flow
medicine.disease
Magnetic Resonance Imaging
Fractional Flow Reserve, Myocardial
Perfusion
Cardiology
Cardiology and Cardiovascular Medicine
business
Coronary physiology
Subjects
Details
- ISSN :
- 18767591
- Volume :
- 13
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- JACC. Cardiovascular imaging
- Accession number :
- edsair.doi.dedup.....d72a97701dc746b51e1b6b9c68781dab