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CLINICAL RESEARCH: CARDIAC IMAGING

Quantitative Magnetic Resonance Perfusion Imaging Detects Anatomic and Physiologic Coronary Artery Disease as Measured by Coronary Angiography and Fractional Flow Reserve

Marco A. Costa, MD, PhD, FACC^_*,_*, Steven Shoemaker, MD^_*, Hideki Futamatsu, MD, PhD^_*, Chris Klassen, MD, Dominick J. Angiolillo, MD, PhD, FACC^_*, Minh Nguyen, MD, Alan Siuciak, MS, Paul Gilmore, MD, FACC^_*, Martin M. Zenni, MD, FACC^_*, Luis Guzman, MD, FACC^_*, Theodore A. Bass, MD, FACC^_* and Norbert Wilke, MD, FACC^_*,

^_* Division of Cardiology, University of Florida Shands Jacksonville, Jacksonville, Florida
Division of Radiology, University of Florida Shands Jacksonville, Jacksonville, Florida.

Manuscript received August 1, 2006; revised manuscript received February 7, 2007, accepted April 3, 2007.

^_* Reprint requests and correspondence: Dr. Marco A. Costa, Assistant Professor of Medicine, Director of Research and Cardiovascular Imaging Core Laboratories, University of Florida Shands Jacksonville, 655 West 8th Street, ACC Building, Cardiovascular Center, Jacksonville, Florida 32209. (Email: marco.costa{at}jax.ufl.edu).

Objectives: To evaluate the ability of quantitative perfusion cardiac magnetic resonance (CMR) to assess the hemodynamic significance of coronary artery disease (CAD) compared with well-established anatomic and physiologic techniques.

Background: Fractional flow reserve (FFR) is considered by many investigators to be a reliable stenosis-specific method to determine hemodynamically significant CAD. Quantitative perfusion CMR is a promising noninvasive approach to detect CAD but has yet to be validated against FFR.

Methods: This is a prospective study in patients with suspected CAD who underwent coronary angiography, FFR, and CMR assessments. The quantitative myocardial perfusion reserve (MPR) was calculated in 720 myocardial sectors (8 sectors/slice). The MPR was calculated from the ratio between stress and rest myocardial flow based on signal intensity time curves using deconvolution analysis. Stress was simulated with adenosine for both FFR and MPR. The MPR assessments were compared to FFR (n = 44 coronary segments) and quantitative coronary angiography (n = 108 segments) in the corresponding coronary territories.

Results: The MPR was 1.54 ± 0.36 in segments with FFR 0.75 (n = 14) and 2.11 ± 0.68 in those with FFR >0.75 (n = 30; p = 0.0054). An MPR cutoff of 2.04 was 92.9% (95% CI 77.9 to 100.0) sensitive and 56.7% (95% CI 32.8 to 80.6) specific in predicting a coronary segment with FFR 0.75. The MPR was 1.54 ± 0.49 in coronary segments with 50% diameter stenosis (DS) (n = 47) and 2.13 ± 0.80 in segments with <50% DS (n = 61; p < 0.001). An MPR cutoff of 2.04 was 85.1% (95% CI 71.1 to 99.2) sensitive and 49.2% (95% CI 33.6 to 64.8) specific in predicting CAD with 50% DS.

Conclusions: Quantitative perfusion CMR is a safe noninvasive test that represents a stenosis-specific alternative to determine the hemodynamic significance of CAD.

Abbreviations and Acronyms   CAD = coronary artery disease   CFR = coronary flow reserve   CI = confidence interval   CMR = cardiac magnetic resonance   DS = diameter stenosis   FFR = fractional flow reserve   LV = left ventricle/ventricular   MPR = myocardial perfusion reserve   QCA = quantitative coronary angiography   SI = signal intensity

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