title: Comparison of myocardial transmural perfusion gradient by magnetic resonance imaging to fractional flow reserve in patients with suspected coronary artery disease.
abstract: The goal of this study was to evaluate the diagnostic accuracy of transmural perfusion gradient (TPG) and transmural perfusion gradient reserve (TPGR) with 3.0 T cardiac magnetic resonance (CMR) against invasively determined fractional flow reserve (FFR) to detect coronary artery stenosis. Quantitative analysis of myocardial perfusion with CMR to diagnosis coronary artery disease (CAD) has been widely accepted. However, traditional transmural myocardial perfusion analysis with CMR neglects that endocardium is more vulnerable to ischemia than epicardium. TPG and TPGR can take the inhomogenous perfusion impairment into account and be more sensitive and specific for diagnosis of CAD. In this study, 71 patients (57 men, age 60.1 ± 6.4 years) with known or suspected CAD referred for invasive angiography study underwent rest and adenosine-induced stress CMR perfusion imaging scan. FFR was attempted to be measured in all major epicardial coronary arteries. FFR ≤0.75 was regarded to indicate a hemodynamic significant coronary lesion. A TPG ≤0.85 predicted significant CAD with sensitivity and specificity of 74.55% and 83.65%, respectively. Sensitivity and specificity of TPGR ≤0.81 were 90.91% and 89.94%, respectively. Area under the receiver-operating curve to detect FFR ≤0.75 was 0.86 for TPG and 0.95 for TPGR. TPGR yielded significantly better sensitivity and specificity for diagnosis of CAD than traditional myocardial blood flow, myocardial perfusion reserve, and TPG (p < 0.0001). In conclusion, TPG and TPGR analyses with MRI are capable of detecting hemodynamic stenosis of coronary artery and superior to traditional myocardial perfusion analysis. Furthermore, TPGR appears to be superior to TPG in the diagnosis of coronary artery stenosis.
authors: Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Jingwei
authors: J
authors: Pan
authors: Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Siyi
authors: S
authors: Huang
authors: Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Zhigang
authors: Z
authors: Lu
authors: Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Jingbo
authors: J
authors: Li
authors: Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Qing
authors: Q
authors: Wan
authors: Department of Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Jiayin
authors: J
authors: Zhang
authors: Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Chengjie
authors: C
authors: Gao
authors: School of Electronic Information and Electrical Engineering, Shanghai Jiaotong University, Shanghai, China.
authors: Xin
authors: X
authors: Yang
authors: Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: drweimeng@163.com.
authors: Meng
authors: M
authors: Wei
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results