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CLINICAL STUDY

Improvement of myocardial perfusion reserve early after coronary intervention: assessment with cardiac magnetic resonance imaging

Manuscript received September 27, 1999; revised manuscript received April 20, 2000, accepted June 19, 2000.

Reprint requests and correspondence: Dr. Eike Nagel, Internal Medicine/Cardiology, German Heart Institute & Charité Campus Virchow, Humboldt University, Augustenburger Platz 1, D-13353 Berlin/Germany
eike.nagel{at}dhzb.de

OBJECTIVES

The purpose of this study was to determine the potential value of magnetic resonance myocardial perfusion in the follow-up of patients after coronary intervention.

BACKGROUND

In some patients a residual impairment of myocardial perfusion reserve (MPR) early after successful coronary intervention has been observed. In this study we evaluated an MPR index before and after intervention with magnetic resonance.

METHODS

Thirty-five patients with single- and multivessel coronary artery disease were studied before and 24 h after intervention. The signal intensity time curves of the first pass of a gadolinium-diethylene triamine pentacetic acid bolus injected via a central vein catheter were evaluated before and after dipyridamole infusion. The upslope was determined using a linear fit. Myocardial perfusion reserve index was estimated from the alterations of the upslope.

RESULTS

The MPR index in segments perfused by the stenotic artery was significantly lower than in the control segments (1.07 ± 0.24 vs. 2.18 ± 0.35, p < 0.001) and improved significantly after intervention (1.89 ± 0.39, p < 0.001) but did not normalize completely (p < 0.01). After intervention the MPR index remained significantly lower in the balloon percutaneous transluminal coronary angioplasty group (1.72 ± 0.38; n = 13) in comparison with the stent group (1.99 ± 0.36, n = 18, p < 0.05). In the stent group a complete normalization of the MPR index was found 24 h after stenting.

CONCLUSIONS

Magnetic resonance perfusion measurements allow a reliable assessment of MPR index. An improvement of MPR index can be observed after coronary intervention, which is more pronounced after stenting. Magnetic resonance perfusion measurements allow the assessment and may be useful for the follow-up of patients with coronary artery disease after coronary intervention.

Abbreviations and Acronyms   CAD = coronary artery disease   ECG = electrocardiogram   LAD = left anterior descending coronary artery   LCX = left circumflex coronary artery   MPR = myocardial perfusion reserve   MR = magnetic resonance   PET = positron emission tomography   PTCA = percutaneous transluminal coronary angioplasty   RCA = right coronary artery

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