Validation of magnetic resonance myocardial perfusion imaging with fractional flow reserve for the detection of significant coronary heart disease.
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.
Watkins
Stuart
S
Golden Jubilee National Hospital, Department of Cardiology, Beardmore St, Clydebank, Glasgow, G81 4HX. stuwatki@hotmail.com
McGeoch
Ross
R
Lyne
Jonathan
J
Steedman
Tracey
T
Good
Richard
R
McLaughlin
Mairi-Jean
MJ
Cunningham
Tony
T
Bezlyak
Vladimir
V
Ford
Ian
I
Dargie
Henry J
HJ
Oldroyd
Keith G
KG
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
D014665:Vasodilator Agents; D005682:Gadolinium; D000241:Adenosine