title: Validation of magnetic resonance myocardial perfusion imaging with fractional flow reserve for the detection of significant coronary heart disease.
abstract: BACKGROUND
  Magnetic resonance myocardial perfusion imaging (MRMPI) has a number of advantages over the other noninvasive tests used to detect reversible myocardial ischemia. The majority of previous studies have generally used quantitative coronary angiography as the gold standard to assess the accuracy of MRMPI; however, only an approximate relationship exists between stenosis severity and functional significance. Pressure wire-derived fractional flow reserve (FFR) values <0.75 correlate closely with objective evidence of reversible ischemia. Accordingly, we have compared MRMPI with FFR.
  
  
  RESULTS
  One hundred three patients referred for investigation of suspected angina underwent MRMPI with a 1.5-T scanner. The stress agent was intravenous adenosine (140 microg . kg(-1) . min(-1)), and the first-pass bolus contained 0.1 mmol/kg gadolinium. In the following week, coronary angiography with pressure wire studies was performed. FFR was recorded in all patent major epicardial coronary arteries, with a value <0.75 denoting significant stenosis. MRMPI scans, analyzed by 2 blinded observers, identified perfusion defects in 121 of 300 coronary artery segments (40%), of which 110 had an FFR <0.75. We also found that 168 of 179 normally perfused segments had an FFR > or = 0.75. The sensitivity and specificity of MRMPI for the detection of functionally significant coronary heart disease were 91% and 94%, respectively, with positive and negative predictive values of 91% and 94%.
  
  
  CONCLUSIONS
  MRMPI can detect functionally significant coronary heart disease with excellent sensitivity, specificity, and positive and negative predictive values compared with FFR.
authors.affiliation: Golden Jubilee National Hospital, Department of Cardiology, Beardmore St, Clydebank, Glasgow, G81 4HX. stuwatki@hotmail.com
authors.forename: Stuart
authors.initials: S
authors.lastname: Watkins
authors.forename: Ross
authors.initials: R
authors.lastname: McGeoch
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lyne
authors.forename: Tracey
authors.initials: T
authors.lastname: Steedman
authors.forename: Richard
authors.initials: R
authors.lastname: Good
authors.forename: Mairi-Jean
authors.initials: MJ
authors.lastname: McLaughlin
authors.forename: Tony
authors.initials: T
authors.lastname: Cunningham
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bezlyak
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Dargie
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
mesh_terms: D000241:Adenosine; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology; D017023:Coronary Angiography / Q000592:standards*; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D005682:Gadolinium; D000241:Adenosine