title: Perfusion cardiovascular magnetic resonance and fractional flow reserve in patients with angiographic multi-vessel coronary artery disease.
abstract: Perfusion cardiovascular magnetic resonance (CMR) and fractional flow reserve (FFR) are emerging as the most accurate tools for the assessment of myocardial ischemia noninvasively or in the catheter laboratory. However, there is limited data comparing CMR and FFR in patients with multi-vessel disease. This study aims to evaluate the correlation between myocardial ischemia detected by CMR with FFR in patients with multivessel coronary disease at angiography.
  
  
  
  Forty-one patients (123 vascular territories) with angiographic 2- or 3-vessel coronary artery disease (visual stenosis >50 %) underwent high-resolution adenosine stress perfusion CMR at 1.5 T and FFR measurement. An FFR value of <0.75 was considered significant. On a per patient basis, CMR and FFR detected identical ischemic territories in 19 patients (46 %) (mean number of territories 0.7+/-0.7 in both (p = 1.0)). On a per vessel basis, 89 out of 123 territories demonstrated concordance between the CMR and FFR results (72 %). In 34 % of the study population, CMR resulted in fewer ischemic territories than FFR; in 12 % CMR resulted in more ischemic territories than FFR. There was good concordance between the two methods to detect myocardial ischemia on a per-patient (k =0.658 95 % CI 0.383-0.933) level and moderate concordance on a per-vessel (k = 0.453 95 % CI 0.294-0.612) basis.
  
  
  
  There is good concordance between perfusion CMR and FFR for the identification of myocardial ischemia in patients with multi-vessel disease. However, some discrepancy remains and at this stage it is unclear whether CMR underestimates or FFR overestimates the number of ischemic segments in multi-vessel disease.
authors.affiliation: Papworth Hospital NHS trust, Papworth Everard, Papworth Everard, Cambridgeshire, UK. shaziathussain@icloud.com.|Cardiology Department, Papworth Hospital, Papworth Everard, CB23 3RE, UK. shaziathussain@icloud.com.
authors.forename: Shazia T
authors.initials: ST
authors.lastname: Hussain
authors.affiliation: 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, UK.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.affiliation: Portsmouth Hospitals NHS trust, Portsmouth, UK.
authors.forename: Geraint
authors.initials: G
authors.lastname: Morton
authors.affiliation: Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Department of Cardiology and Pulmonology and German Centre for Cardiovascular Research, Göttingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuster
authors.affiliation: Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Paul
authors.affiliation: 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, UK.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.affiliation: DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt/Main, Frankfurt/Main, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Coronary artery disease; Fractional flow reserve; Ischemia; Perfusion CMR