title: Cardiac magnetic resonance myocardial perfusion imaging for detection of functionally significant obstructive coronary artery disease: a prospective study.
abstract: BACKGROUND
  Cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) is considered a state of the art non-invasive modality for the detection of reversible ischemia. Recent studies have shown its utility in the diagnosis of coronary artery disease (CAD) and superiority over other established techniques. However, only a few studies compared CMR-MPI against the invasive standard including fractional flow reserve (FFR) and clinical validation in non-specialized centers is scarce. The aim of this study was to validate CMR-MPI in a real-world clinical environment and to test its diagnostic accuracy in symptomatic patients with suspected CAD versus FFR as the reference standard of functionally significant disease.
  
  
  RESULTS
  103 symptomatic consecutive patients (62 ± 8.0 years, 66% males) with suspected CAD and intermediate or high probability of disease underwent sequential CMR and invasive coronary angiography (XA). The CMR protocol included stress-rest adenosine perfusion, SSFP cine imaging and late-enhancement imaging. Functionally significant CAD was defined as occlusive/sub-occlusive stenoses on XA or non-occlusive stenoses with a FFR measurement of <0.80 in vessels >2mm. On a patient-based model, CMR-MPI had sensitivity, specificity, positive and negative predictive values of 89%, 88%, 85%, and 91%, respectively, with a global accuracy of 88%. On a vessel-based analysis, these values were 80%, 93%, 79% and 94%, respectively, with a global accuracy of 90%.
  
  
  CONCLUSIONS
  CMR-MPI had a very high accuracy for detection of functionally significant CAD as assessed by FFR in patients with intermediate to high pretest probability.
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Portugal; Kings College London, United Kingdom; Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal. Electronic address: bettencourt.n@gmail.com.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuster
authors.forename: Nuno
authors.initials: N
authors.lastname: Ferreira
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.forename: Ricardo
authors.initials: R
authors.lastname: Duarte
authors.forename: Lino
authors.initials: L
authors.lastname: Santos
authors.forename: Bruno
authors.initials: B
authors.lastname: Melica
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga
authors.forename: Madalena
authors.initials: M
authors.lastname: Teixeira
authors.forename: Lino
authors.initials: L
authors.lastname: Simões
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
authors.forename: José
authors.initials: J
authors.lastname: Silva-Cardoso
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.forename: Pedro
authors.initials: P
authors.lastname: Portugal
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies
keywords: Adenosine; Cardiac magnetic resonance; Coronary artery disease; Fractional flow reserve; Perfusion; Stress testing