Multi-centre study of whole-heart dynamic 3D cardiac magnetic resonance perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve: gender based analysis of diagnostic performance

Hamada, Sandra; Gotschy, Alexander; Wissmann, Lukas; Paetsch, Ingo; Jahnke, Cosima; Plein, Sven; Gebker, Rolf; Oebel, Sabrina; Alkadhi, Hatem; Lüscher, Thomas F.; Kozerke, Sebastian; Manka, Robert

doi:10.1093/ehjci/jex160

Cited by 10 publications

(19 citation statements)

References 24 publications

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“…However, no single noninvasive method has yet reached clinical applicability in terms of enabling a reliable diagnosis of microvascular ischemia. In current clinical practice, the diagnosis of microvascular ischemia is based on the presence of myocardial ischemia on functional perfusion imaging, i.e., MRI 35 – 37 , CTP 38 , or positron emission tomography (PET) 39 , in the absence of coronary stenosis on either coronary angiography including an option for acetylcholine testing 40 or CCTA, which has high diagnostic accuracy for noninvasive detection of macrovascular CAD 41 , 42 . While the pathophysiological relation between epicardial vessel wall remodeling and resultant pathophysiological consequences for myocardial blood flow (MBF) has been studied 43 , imaging of the microcirculation remains challenging.…”

Section: Discussionmentioning

confidence: 99%

Fractal analysis of 4D dynamic myocardial stress-CT perfusion imaging differentiates micro- and macrovascular ischemia in a multi-center proof-of-concept study

Michallek

Nakamura

Ota

et al. 2022

Sci Rep

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Fractal analysis of dynamic, four-dimensional computed tomography myocardial perfusion (4D-CTP) imaging might have potential for noninvasive differentiation of microvascular ischemia and macrovascular coronary artery disease (CAD) using fractal dimension (FD) as quantitative parameter for perfusion complexity. This multi-center proof-of-concept study included 30 rigorously characterized patients from the AMPLIFiED trial with nonoverlapping and confirmed microvascular ischemia (nmicro = 10), macrovascular CAD (nmacro = 10), or normal myocardial perfusion (nnormal = 10) with invasive coronary angiography and fractional flow reserve (FFR) measurements as reference standard. Perfusion complexity was comparatively high in normal perfusion (FDnormal = 4.49, interquartile range [IQR]:4.46–4.53), moderately reduced in microvascular ischemia (FDmicro = 4.37, IQR:4.36–4.37), and strongly reduced in macrovascular CAD (FDmacro = 4.26, IQR:4.24–4.27), which allowed to differentiate both ischemia types, p < 0.001. Fractal analysis agreed excellently with perfusion state (κ = 0.96, AUC = 0.98), whereas myocardial blood flow (MBF) showed moderate agreement (κ = 0.77, AUC = 0.78). For detecting CAD patients, fractal analysis outperformed MBF estimation with sensitivity and specificity of 100% and 85% versus 100% and 25%, p = 0.02. In conclusion, fractal analysis of 4D-CTP allows to differentiate microvascular from macrovascular ischemia and improves detection of hemodynamically significant CAD in comparison to MBF estimation.

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Section: Discussionmentioning

confidence: 99%

Fractal analysis of 4D dynamic myocardial stress-CT perfusion imaging differentiates micro- and macrovascular ischemia in a multi-center proof-of-concept study

Michallek

Nakamura

Ota

et al. 2022

Sci Rep

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“…78 Whole--heart dynamic CMR perfusion is based on a new 3D acquisition sequences that allow readout of the entire examination volume at once in contrast to routinely used 2D acquisition of separate slices. [78][79][80][81][82][83][84] Hybrid imaging holds promise for the field of cardiac imaging and planning of myocardial revascularization. It may be of particular value in multivessel disease, where the simultaneous…”

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confidence: 99%

Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art

Sokolska¹,

Spiczak²,

Gotschy³

et al. 2019

Kardiol Pol

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The new 2019 European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes emphasize the role of noninvasive functional imaging of myocardial ischemia in diagnosing coronary artery disease to guide decision making regarding revascularization. Cardiac magnetic resonance imaging (CMR) stands out relative to other imaging modalities given its high safety profile, absence of ionizing radiation, and its versatility in encoding various image contrasts. It also allows an assessment of myocardial function, ischemia, and viability as well as permits tissue characterization including detection of edema in a single examination. In recent years, a number of meta-analyses and studies considering the role of CMR for detecting ischemia have been published. The recent multicenter randomized MR-INFORM trial has demonstrated the clinical utility of CMR in patients with stable angina and cardiovascular risk factors. This landmark study has proved that a perfusion CMR-based strategy leads to a lower number of revascularizations while being noninferior to an invasive coronary angiography with fractional flow reserve-guided therapy in terms of major adverse cardiac events at 1 year. In light of recent and future technical improvements, CMR will become increasingly important in the assessment of myocardial ischemia in patients with chronic coronary syndromes.

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“…In a study by Hamada et al, 27 whole‐heart 3‐D perfusion MRI demonstrated high diagnostic accuracy for significant CAD irrespective of gender. Notably, they showed a high sensitivity of 89% and NPV of 90% for female populations, which are often considered to be an undertreated demographic 27 . The disadvantages of current 3‐D MR perfusion techniques include the relatively poor in‐plane spatial resolution (2.3 × 2.3 mm 2 ) and the long temporal footprint 28 .…”

Section: Discussionmentioning

confidence: 97%

Diagnostic Accuracy of Spiral Whole‐Heart Quantitative Adenosine Stress Cardiovascular Magnetic Resonance With Motion Compensated L1‐SPIRIT

Pan

Yang

Lozano

et al. 2021

Magnetic Resonance Imaging

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Background Variable density spiral (VDS) pulse sequences with motion compensated compressed sensing (MCCS) reconstruction allow for whole‐heart quantitative assessment of myocardial perfusion but are not clinically validated. Purpose Assess performance of whole‐heart VDS quantitative stress perfusion with MCCS to detect obstructive coronary artery disease (CAD). Study Type Prospective cross sectional. Population Twenty‐five patients with chest pain and known or suspected CAD and nine normal subjects. Field strength/Sequence Segmented steady‐state free precession (SSFP) sequence, segmented phase sensitive inversion recovery sequence for late gadolinium enhancement (LGE) imaging and VDS sequence at 1.5 T for rest and stress quantitative perfusion at eight short‐axis locations. Assessment Stenosis was defined as ≥50% by quantitative coronary angiography (QCA). Visual and quantitative analysis of MRI data was compared to QCA. Quantitative analysis assessed average myocardial perfusion reserve (MPR), average stress myocardial blood flow (MBF), and lowest stress MBF of two contiguous myocardial segments. Ischemic burden was measured visually and quantitatively. Statistical Tests Student's t‐test, McNemar's test, chi‐square statistic, linear mixed‐effects model, and area under receiver‐operating characteristic curve (ROC). Results Per‐patient visual analysis demonstrated a sensitivity of 84% (95% confidence interval [CI], 60%–97%) and specificity of 83% [95% CI, 36%–100%]. There was no significant difference between per‐vessel visual and quantitative analysis for sensitivity (69% [95% CI, 51%–84%] vs. 77% [95% CI, 60%–90%], P = 0.39) and specificity (88% [95% CI, 73%–96%] vs. 80% [95% CI, 64%–91%], P = 0.75). Per‐vessel quantitative analysis ROC showed no significant difference (P = 0.06) between average MPR (0.68 [95% CI, 0.56–0.81]), average stress MBF (0.74 [95% CI, 0.63–0.86]), and lowest stress MBF (0.79 [95% CI, 0.69–0.90]). Visual and quantitative ischemic burden measurements were comparable (P = 0.85). Data Conclusion Whole‐heart VDS stress perfusion demonstrated good diagnostic accuracy and ischemic burden evaluation. No significant difference was seen between visual and quantitative diagnostic performance and ischemic burden measurements. Evidence Level 2 Technical Efficacy Stage 2

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Multi-centre study of whole-heart dynamic 3D cardiac magnetic resonance perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve: gender based analysis of diagnostic performance

Abstract: Whole-heart dynamic 3D CMR stress perfusion imaging has a high diagnostic accuracy for the detection of significant CAD irrespective of gender and is therefore a suitable non-invasive testing tool to detect myocardial ischaemia in both genders.

Cited by 10 publications

References 24 publications

Fractal analysis of 4D dynamic myocardial stress-CT perfusion imaging differentiates micro- and macrovascular ischemia in a multi-center proof-of-concept study

Fractal analysis of 4D dynamic myocardial stress-CT perfusion imaging differentiates micro- and macrovascular ischemia in a multi-center proof-of-concept study

Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art

Diagnostic Accuracy of Spiral Whole‐Heart Quantitative Adenosine Stress Cardiovascular Magnetic Resonance With Motion Compensated L1‐SPIRIT

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