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J Am Coll Cardiol, 1999; 33:1386-1394
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

A myocardial perfusion reserve index in humans using first-pass contrast-enhanced magnetic resonance imaging

J. H. S. Cullen, MA, MRCP* {dagger}, M. A. Horsfield, PhD, MIEE{ddagger}, C. R. Reek, FRCR§, G. R. Cherryman, MD, FRCR§, D. B. Barnett, MD, FRCP{dagger} and N. J. Samani, MD, FRCP, FACC*

* Division of Cardiology, Department of Medicine and Therapeutics, University of Leicester, Leicester, England, United Kingdom
{dagger} Department of Clinical Pharmacology, University of Leicester, Leicester, England, United Kingdom
{ddagger} Department of Medical Physics, University of Leicester, Leicester, England, United Kingdom
§ Department of Radiology, University of Leicester, Leicester, England, United Kingdom

Manuscript received February 9, 1998; revised manuscript received November 13, 1998, accepted December 24, 1998.

Reprint requests and correspondence: Dr. James Cullen, Department of Cardiology, Glenfield Hospital, Groby Road, Leicester, Leics LE3 9QP, United Kingdom.
James.Cullen{at}btinternet.com

OBJECTIVES

The purpose of this study was to evaluate a myocardial perfusion reserve index (MPRI) derived from a quantitative magnetic resonance imaging (MRI) technique in normal human volunteers and patients with coronary artery disease and to relate MPRI to coronary artery stenosis severity measured with quantitative arteriography.

BACKGROUND

Magnetic resonance imaging could be a useful noninvasive tool in the investigation of ischemic heart disease. However, there have been few studies in humans to quantify myocardial perfusion and myocardial perfusion reserve using MRI and none in patients with coronary disease.

METHODS

Twenty patients with angiographically proven coronary artery disease and five normal volunteers underwent both resting and stress (adenosine 140 µg/kg–1/min–1) first-pass contrast-enhanced MRI examinations (using 0.05 mmol/kg–1 of gadopentetate dimeglumine. Using a tracer kinetic model, the unidirectional transfer constant (Ki), a perfusion marker for the myocardial uptake of contrast, was computed in each coronary arterial territory. The ratio of Ki for the rest and stress scans was used to calculate the MPRI. Percent reduction in luminal diameter of coronary lesions was measured using an automated edge-detection algorithm.

RESULTS

Myocardial perfusion reserve index was significantly reduced in patients compared with normal subjects (2.02 ± 0.7 vs. 4.21 ± 1.16, p < 0.02). For regions supplied by individual vessels, there was a significant negative correlation of MPRI with percent diameter stenosis (r = –0.81, p < 0.01). Importantly, regions supplied by vessels with <40% diameter stenosis (non–flow limiting) had a significantly higher MPRI than regions supplied by stenoses of "intermediate" severity, that is, >40% to 59% diameter stenosis (2.80 ± 0.77 and 1.93 ± 0.38, respectively, p < 0.02). However, even regions supplied by vessels with <40% diameter stenosis had a significantly lower MPRI than volunteers (p < 0.01).

CONCLUSIONS

A myocardial perfusion reserve index derived from first-pass MRI studies can distinguish between normal subjects and patients with coronary artery disease. Furthermore, it provides useful functional information on coronary lesions, particularly where the physiologic significance cannot be predicted accurately from the angiogram.

Abbreviations and Acronyms
  E = extraction
  F = perfusion
  FLASH = fast low angle shot
  Gd-DTPA = gadopentetate dimeglumine
  Ki = unidirectional transfer constant
  MPRI = myocardial perfusion reserve index
  MRI = magnetic resonance imaging
  PET = positron-emission tomography
  R1 = myocardial relaxation rate
  ROI = region of interest




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