title: Ischemic burden by 3-dimensional myocardial perfusion cardiovascular magnetic resonance: comparison with myocardial perfusion scintigraphy.
abstract: BACKGROUND
  The extent and severity of ischemia on myocardial perfusion scintigraphy (MPS) is commonly used to risk-stratify patients with coronary artery disease. Estimation of ischemic burden by cardiovascular magnetic resonance (CMR) with conventional 2-dimensional myocardial perfusion methods is limited by incomplete cardiac coverage. More recently developed 3-dimensional (3D) myocardial perfusion CMR, however, provides whole-heart coverage. The aim of this study was to compare ischemic burden on 3D myocardial perfusion CMR with (99m)Tc-tetrofosmin MPS.
  
  
  RESULTS
  Forty-five patients who had undergone clinically indicated MPS underwent rest and adenosine stress 3D myocardial perfusion and late gadolinium enhancement CMR. Summed stress and rest scores were calculated for MPS and CMR using a 17-segment model and expressed as a percentage of the maximal possible score. Ischemic burden was defined as the difference between stress and rest scores. 3D myocardial perfusion CMR and MPS agreed in 38 of the 45 patients for the detection of any inducible ischemia. The mean ischemic burden for MPS and CMR was similar (7.5±8.9% versus 6.8±9.5%, respectively, P=0.82) with a strong correlation between techniques (rs=0.70, P<0.001). In a subset of 33 patients who underwent clinically indicated invasive coronary angiography, sensitivities and specificities of the 2 techniques to detect angiographic coronary artery disease were similar (McNemar P=0.45).
  
  
  CONCLUSIONS
  3D myocardial perfusion CMR is an alternative to MPS for detecting the presence and rating the severity of ischemia.
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: Roy
authors.initials: R
authors.lastname: Jogiya
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: Geraint
authors.initials: G
authors.lastname: Morton
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: Kalpa
authors.initials: K
authors.lastname: De Silva
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: Eliana
authors.initials: E
authors.lastname: Reyes
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kozerke
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
authors.forename: S Richard
authors.initials: SR
authors.lastname: Underwood
authors.affiliation: From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.). s.plein@leeds.ac.uk.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
mesh_terms: D000328:Adult; D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: cardiac-gated single-Photon emission computer-assisted tomography; coronary artery disease; magnetic resonance imaging; myocardial infarction; myocardial ischemia