Assessment of advanced coronary artery disease: Advantages of quantitative cardiac magnetic resonance perfusion analysis

Amit R. Patel, Patrick F. Antkowiak, Kiran R. Nandalur, Amy M. West, Michael Salerno, Vishal Arora, John Christopher, Frederick H. Epstein, Christopher M. Kramer

Research output: Contribution to journalArticle

102 Scopus citations

Abstract

Objectives: The purpose of this paper was to compare quantitative cardiac magnetic resonance (CMR) first-pass contrast-enhanced perfusion imaging to qualitative interpretation for determining the presence and severity of coronary artery disease (CAD). Background: Adenosine CMR can detect CAD by measuring perfusion reserve (PR) or by qualitative interpretation (QI). Methods: Forty-one patients with an abnormal nuclear stress scheduled for X-ray angiography underwent dual-bolus adenosine CMR. Segmental myocardial perfusion analyzed using both QI and PR by Fermi function deconvolution was compared to quantitative coronary angiography. Results: In the 30 patients with complete quantitative data, PR (mean ± SD) decreased stepwise as coronary artery stenosis (CAS) severity increased: 2.42 ± 0.94 for <50%, 2.14 ± 0.87 for 50% to 70%, and 1.85 ± 0.77 for >70% (p < 0.001). The PR and QI had similar diagnostic accuracies for detection of CAS >50% (83% vs. 80%), and CAS >70% (77% vs. 67%). Agreement between observers was higher for quantitative analysis than for qualitative analysis. Using PR, patients with triple-vessel CAD had a higher burden of detectable ischemia than patients with single-vessel CAD (60% vs. 25%; p = 0.02), whereas no difference was detected by QI (31% vs. 21%; p = 0.26). In segments with myocardial scar (n = 64), PR was 3.10 ± 1.34 for patients with CAS <50% (n = 18) and 1.91 ± 0.96 for CAS >50% (p < 0.0001). Conclusions: Quantitative PR by CMR differentiates moderate from severe stenoses in patients with known or suspected CAD. The PR analysis differentiates triple- from single-vessel CAD, whereas QI does not, and determines the severity of CAS subtending myocardial scar. This has important implications for assessment of prognosis and therapeutic decision making.

Original languageEnglish (US)
Pages (from-to)561-569
Number of pages9
JournalJournal of the American College of Cardiology
Volume56
Issue number7
DOIs
StatePublished - Aug 10 2010

Keywords

  • AIF
  • CAD
  • CAS
  • CMR
  • ENDO/EPI
  • GRE-EPI
  • Gd-DTPA
  • PR
  • QI
  • TE
  • TF
  • TI
  • TR
  • arterial input function
  • cardiac magnetic resonance
  • coronary artery disease
  • coronary artery stenosis
  • echo time
  • endocardial to epicardial blood flow ratio
  • gadolinium-diethylenetriamine penta-acetic acid
  • hybrid gradient echo/echo planar imaging
  • inversion time
  • perfusion reserve
  • qualitative interpretation
  • repetition time
  • tissue function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Patel, A. R., Antkowiak, P. F., Nandalur, K. R., West, A. M., Salerno, M., Arora, V., Christopher, J., Epstein, F. H., & Kramer, C. M. (2010). Assessment of advanced coronary artery disease: Advantages of quantitative cardiac magnetic resonance perfusion analysis. Journal of the American College of Cardiology, 56(7), 561-569. https://doi.org/10.1016/j.jacc.2010.02.061