CORRESPONDENCE: LETTER TO THE EDITOR
Perfusion Cardiovascular Magnetic Resonance in the Clinical Scenario of Patients With Coronary Artery Disease
Chiara Bucciarelli-Ducci, MD,
Carlo Di Mario, MD, PhD and
Dudley J. Pennell, MD*
* Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom (Email: d.pennell{at}ic.ac.uk).
In the recent paper by Patel et al. (1), the investigators stated that cardiovascular magnetic resonance (CMR) and coronary multislice computed tomography angiography "do not currently provide information on ischemic burden and are not assumed to be present in the clinical scenarios;" in other words, they are not suitable to assess appropriateness of indications for coronary revascularization.
An increasing amount of literature supports the clinical application of stress CMR (performed with adenosine/dipyridamole, or more frequently, dobutamine infusion) in patients with coronary artery disease (CAD) (2–4). Perfusion CMR has been validated against positron emission tomography and quantitative coronary angiography in patients with ischemic heart disease (5,6). Schwitter et al. (5) demonstrated a sensitivity and specificity of 91% and 94% versus positron emission tomography and of 87% and 85% versus quantitative coronary angiography. A myocardial perfusion reserve index derived by perfusion CMR images can distinguish between normal subjects and patients with CAD (7–10). Nandalur et al. (11) recently conducted a meta-analysis of 37 studies on the diagnostic efficacy of stress CMR in the detection of CAD and concluded that stress CMR, using either vasodilator or dobutamine, had high sensitivity and specificity for the diagnosis of CAD.
Possible advantages of perfusion CMR over myocardial perfusion scintigraphy include higher resolution imaging that discriminates between subendocardial and transmural perfusion defects, and no need for additional radiation burden in patients who are often in need of subsequent angioplasty (12). The MR-IMPACT (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial) multicenter study recently demonstrated that CMR perfusion has similar, if not superior, diagnostic performance to myocardial perfusion scintigraphy in the detection of CAD (13). Although myocardial perfusion scintigraphy is a robust technique with extensive prognostic data, there is now increasing evidence of the prognostic value of stress CMR in patients with known or suspected CAD (14–18).
Both the American College of Cardiology Foundation/American Heart Association's 2005 Clinical Competence Statement on Cardiac Imaging with Computed Tomography and CMR and the 2008 Training Statement on Multimodality Noninvasive Cardiovascular Imaging published in previous issues of the Journal refer to perfusion CMR as a valid clinical diagnostic tool for guidance of coronary revascularization therapy (19,20).
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1. Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 appropriateness criteria for coronary revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology J Am Coll Cardiol 2009;53:530-553.[Free Full Text]2. Nagel E, Lehmkuhl HB, Bocksch W, et al. Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography Circulation 1999;99:763-770.[Abstract/Free Full Text] 3. Gerber BL, Raman SV, Kayak K, et al. Myocardial first pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art J Cardiovasc Magn Reson 2008;28:1-18. 4. Schwitter J. Myocardial perfusion imaging by cardiac magnetic resonance J Nucl Cardiol 2006;13:841-854.[CrossRef][Web of Science][Medline] 5. Schwitter J, Nanz D, Kneifel S, et al. Assessment of myocardial perfusion in coronary artery disease by magnetic resonance. A comparison with positron emission tomography and coronary angiography. Circulation 2001;103:2230-2235.[Abstract/Free Full Text] 6. Ibrahim T, Nekolla SG, Schreiber K, et al. Assessment of coronary flow reserve: comparison between contrast-enhanced magnetic resonance imaging and positron emission tomography J Am Coll Cardiol 2002;39:864-870.[Abstract/Free Full Text] 7. Cullen JHS, Horsfield MA, Reek CR, et al. A myocardial perfusion reserve index in humans using first-pass contrast-enhanced magnetic resonance imaging J Am Coll Cardiol 1999;33:1386-1394.[Abstract/Free Full Text] 8. Al-Saadi N, Nagel E, Gross M, et al. Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance Circulation 2000;101:1379-1383.[Abstract/Free Full Text] 9. Nagel E, Klein C, Paetsch I, et al. Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease Circulation 2003;108:432-437.[Abstract/Free Full Text] 10. Kurita T, Sakuma H, Onishi K, et al. Regional myocardial perfusion reserve determined using myocardial perfusion magnetic resonance imaging showed a direct correlation with coronary flow velocity reserve by Doppler flow wire Eur Heart J 2009;30:444-452.[Abstract/Free Full Text] 11. Nandalur KR, Dwamena BA, Choudhri AF, et al. Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease. A meta-analysis. J Am Coll Cardiol 2007;50:1343-1353.[Abstract/Free Full Text] 12. Berman DS, Hachamovitch R, Shaw LJ, et al. Roles of nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance: assessment of patients with suspected coronary artery disease J Nucl Med 2006;47:74-82.[Abstract/Free Full Text] 13. Schwitter J, Wacker CM, van Rossum AC, et al. MR-IMPACT: comparison of perfusion cardiac magnetic resonance with single photon emission computed tomography for the detection of coronary artery disease in a multicenter, multivendor, randomized trial Eur Heart J 2008;29:480-489.[Abstract/Free Full Text] 14. Ingkanisorn WP, Kwong RW, Bohme NS, et al. Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain J Am Coll Cardiol 2006;47:1427-1432.[Abstract/Free Full Text] 15. Jahnke C, Nagel E, Gebker R, et al. Prognostic values of cardiac magnetic resonance stress tests. Adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation 2007;115:1769-1776.[Abstract/Free Full Text] 16. Bodi V, Sanchis J, Lopez-Lereu MP, et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspect coronary artery disease J Am Coll Cardiol 2007;50:1174-1179.[Abstract/Free Full Text] 17. Pilz G, Jeske A, Klos M, et al. Prognostic value of normal adenosine stress cardiac magnetic resonance imaging Am J Cardiol 2008;101:1408-1412.[CrossRef][Web of Science][Medline] 18. Bodi V, Sanchis J, Lopez-Lereu MP, et al. Prognostic and therapeutic implications of dipyridamole stress cardiovascular magnetic resonance on the basis of the ischaemic cascade Heart 2009;95:49-55.[Abstract/Free Full Text] 19. Budoff MJ, Cohen MC, Garcia MJ, et al. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training J Am Coll Cardiol 2005;46:383-402.[Free Full Text] 20. Thomas JD, Zoghbi WA, Beller GA, et al. ACCF 2008 training statement on multimodality noninvasive cardiovascular imaging: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training J Am Coll Cardiol 2009;53:125-146.[Free Full Text]
Related Article
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ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography
- Manesh R. Patel, Gregory J. Dehmer, John W. Hirshfeld, Peter K. Smith, and John A. Spertus
J. Am. Coll. Cardiol. 2009 53: 530-553.
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