Diagnostic Performance and Clinical Utility of Myocardial Perfusion MRI for Coronary Artery Disease with Fractional Flow Reserve as the Standard Reference: A Meta-analysis

Jiang, Binghu; Cai, Wei; Lv, Xianjun; Liu, Huaijun

doi:10.1016/j.hlc.2016.02.018

Cited by 11 publications

(14 citation statements)

References 34 publications

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“…On review of previously published meta-analyses, we noticed inconsistencies in the number of included studies. More contemporary studies did not always include all previously published data and had additional limitations due to outcome biases [2, [33][34][35][36][37]. Studies more stringent in their inclusion criteria, perhaps overestimated the diagnostic accuracy of SCMR owing to a positive selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…Vessel-level sensitivity analysis showed a similar discordance across all included studies. A common limitation observed was a lack of stratification based on the different diagnostic thresholds for SCMR perfusion scans and FFR [34][35][36][37]. The study of Desai et al was the only one that used an FFR diagnostic threshold of 0.75 as opposed to the standard 0.80, hampering the sensitivity of the SCMR perfusion scan by classifying a significant population of patients having FFR of 0.75 -0.80 as falsely "normal" [33].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR. Methods: Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (Rev-Man) 5.3 and Stata software. Results: A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on the FFR thresholds, higher sensitivity and specificity (both 90%) were noted with the higher cutoff (0.75) and lower cutoff (0.8), respectively. At the vessel level, sensitivity and specificity at the lower FFR threshold were significantly higher at 88% and 89%, compared to the corresponding values for higher cutoff at 0.75. Similarly, meta-regression analysis of SCMR at higher (3T) resolution showed a higher sensitivity of 87% at the patient level and higher specificity of 90% at the vessel level. The highest sensitivity and specificity of SCMR (92% and 94%, respectively) were noted in studies with CAD prevalence greater than 60%. Conclusions: SCMR has high diagnostic accuracy for CAD comparable to FFR at a spatial resolution of 3T and an FFR cutoff of 0.80. An increase in CAD prevalence further improved the specificity of SCMR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis

et al. 2020

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“…A number of recent studies of perfusion CMR have used invasive FFR as a reference standard with good results. [9, 30] A meta-analysis by Jiang et al reports a sensitivity and specificity of 88% each when FFR is used as a reference standard. Future studies of the rapid ungated approach could possibly be better validated using FFR as the reference standard in all patients, even in patients without stenoses that appear significant by visual assessment.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, non-invasive imaging for assessment of CAD can be challenging in patients with atrial fibrillation (AF)[7]. Although multiple studies have shown sensitivity and specificity of perfusion CMR for obstructive CAD greater than 80%,[2–4, 8, 9] diagnostic accuracy of this modality has received little study in patients with AF. Greulich et al recently reported a diagnostic accuracy of 70% in 64 patients with AF using a standard ECG-gated breath-hold perfusion CMR protocol[10].…”

Section: Introductionmentioning

confidence: 99%

Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation

Bieging

Haider

Adluru

et al. 2017

Int J Cardiovasc Imaging

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Purpose Cardiovascular magnetic resonance (CMR) perfusion has been established as a useful imaging modality for the detection of coronary artery disease (CAD). However, there are several limitations when applying standard, ECG-gated stress/rest perfusion CMR to patients with atrial fibrillation (AF). In this study we investigate an approach with no ECG gating and a rapid rest/stress perfusion protocol to determine its accuracy for detection of CAD in patients with AF. Methods 26 patients with AF underwent a rapid rest/regadenoson stress CMR perfusion imaging protocol, and all patients had X-ray coronary angiography. An ungated radial myocardial perfusion sequence was used. Imaging protocol included: rest perfusion image acquisition, followed nearly immediately by administration of regadenoson to induce hyperemia, 60 second wait, and stress image acquisition. CMR perfusion images were interpreted by three blinded readers as normal or abnormal. Diagnostic accuracy was evaluated by comparison to X-ray angiography. Results 21 of the CMR rest/stress perfusion scans were negative, and 5 were positive by angiography criteria. Majority results of the ungated datasets from all of the readers showed a sensitivity, specificity and accuracy of 80%, 100% and 96%, respectively, for detection of CAD. Conclusions An ungated, rapid rest/stress regadenoson perfusion CMR protocol appears to be useful for the diagnosis of obstructive CAD in patients with AF.

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“… Stress perfusion cardiac magnetic resonance (CMR) has been proposed as an important gatekeeper for invasive coronary angiography (ICA) and percutaneous coronary interventions (PCI) in patients evaluated for possible coronary artery disease (CAD) (Fihn et al, 2012; Montalescot et al, 2013) [1] , [2] . Several meta-analyses have evaluated the accuracy of stress perfusion CMR to diagnose CAD at the vessel level (Danad et al, 2017; Dai et al, 2016; Jiang et al, 2016; Takx et al, 2015; Li et al, 2015; Desai and Jha, 2013; Jaarsma et al 2012; Hamon et al, 2010; Nandalur et al 2007) [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . However, they included in the same analysis studies with different definitions of significant CAD (i.e.…”

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confidence: 99%

Data on diagnostic performance of stress perfusion cardiac magnetic resonance for coronary artery disease detection at the vessel level

et al. 2018

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Stress perfusion cardiac magnetic resonance (CMR) has been proposed as an important gatekeeper for invasive coronary angiography (ICA) and percutaneous coronary interventions (PCI) in patients evaluated for possible coronary artery disease (CAD) (Fihn et al., 2012; Montalescot et al., 2013) [1], [2]. Several meta-analyses have evaluated the accuracy of stress perfusion CMR to diagnose CAD at the vessel level (Danad et al., 2017; Dai et al., 2016; Jiang et al., 2016; Takx et al., 2015; Li et al., 2015; Desai and Jha, 2013; Jaarsma et al. 2012; Hamon et al., 2010; Nandalur et al. 2007) [3], [4], [5], [6], [7], [8], [9], [10], [11]. However, they included in the same analysis studies with different definitions of significant CAD (i.e. fractional flow reserve [FFR] < 0.75 and < 0.80 or coronary stenosis ≥ 50% and ≥ 70%), magnetic field strength (1.5 or 3 Tesla [T]), and study protocol (integration or not of late gadolinium enhancement [LGE] into stress perfusion protocol). Data of 34 studies (6091 arteries) have been pooled with the aim of analyzing the accuracy of stress perfusion CMR for the diagnosis of ischemic heart disease at the vessel level according to different definitions of significant CAD, magnetic field strength and study protocol (Arnold et al., 2010; Bettencourt et al., 2013; Cheng et al., 2007; Chiribiri et al., 2013; Cury et al., 2006; De Mello et al., 2012; Donati et al., 2010; Ebersberger et al., 2013; Gebker et al., 2008; Greulich et al., 2015; Hussain et al., 2016; Ishida et al., 2005, 2003; Kamiya et al., 2014; Kitagawa et al., 2008; Klein et al., 2008; Klem et al., 2006; Klumpp et al., 2010; Krittayaphong et al., 2009; Lockie et al., 2011; Ma et al., 2012; Merkle et al., 2007; Meyer et al., 2008; Mor-Avi et al., 2008; Pan et al., 2015; Papanastasiou et al., 2016; Pons Lladó et al., 2004; Sakuma et al., 2005; Salerno et al., 2014; Scheffel et al., 2010; van Werkhoven et al., 2010; Walcher et al., 2013; Watkins et al., 2009; Yun et al., 2015) [12–45]. This article describes data related article titled “Diagnostic Performance of Stress Perfusion Cardiac Magnetic Resonance for the Detection of Coronary Artery Disease” (Kiaos et al., submitted for publication) [46].

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Diagnostic Performance and Clinical Utility of Myocardial Perfusion MRI for Coronary Artery Disease with Fractional Flow Reserve as the Standard Reference: A Meta-analysis

Cited by 11 publications

References 34 publications

Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis

Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation

Data on diagnostic performance of stress perfusion cardiac magnetic resonance for coronary artery disease detection at the vessel level

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