Validation of Magnetic Resonance Myocardial Perfusion Imaging with Fractional Flow Reserve for the Detection of Significant Coronary Heart Disease

OBJECTIVES: Magnetic resonance myocardial perfusion imaging (MRMPI) has a number of advantages over the other noninvasive tests used to detect reversible myocardial ischemia. The majority of previous studies have generally used quantitative coronary angiography as the gold standard to assess the accuracy of MRMPI; however, only an approximate relationship exists between stenosis severity and functional significance. Pressure wire-derived fractional flow reserve (FFR) values <0.75 correlate closely with objective evidence of reversible ischemia. Accordingly, we have compared MRMPI with FFR.

METHODS: One hundred three patients referred for investigation of suspected angina underwent MRMPI with a 1.5-T scanner. The stress agent was intravenous adenosine (140 microg . kg(-1) . min(-1)), and the first-pass bolus contained 0.1 mmol/kg gadolinium. In the following week, coronary angiography with pressure wire studies was performed. FFR was recorded in all patent major epicardial coronary arteries, with a value <0.75 denoting significant stenosis.

RESULTS: MRMPI scans, analyzed by 2 blinded observers, identified perfusion defects in 121 of 300 coronary artery segments (40%), of which 110 had an FFR <0.75. We also found that 168 of 179 normally perfused segments had an FFR > 0.75. The sensitivity and specificity of MRMPI for the detection of functionally significant coronary heart disease were 91% and 94%, respectively, with positive and negative predictive values of 91% and 94%.

CONCLUSIONS: MRMPI can detect functionally significant coronary heart disease with excellent sensitivity, specificity, and positive and negative predictive values compared with FFR. Doug Martin Womens Jersey

PMID: 19917885

Posted in Magnetic Resonance Imaging and tagged , , , , .

2 Comments

  1. Well designed study in a large cohort (101) of patients with suspected angina undergoing both studies within a week of each other.
    The per-patient analysis resulted in a sensitivity, specificity, PPV, and NPV of MRMPI of 95%, 91%, 97%, and 84%, respectively.
    Additionally, this study also reminds us of the limitations of QCA in assessing the functional significance of coronary artery disease.

  2. Important data!
    In this context, also look at studies that compare anatomic luminal stenosis with FFR:

    Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina.
    Meijboom WB, Van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, Boersma E, Regar E, van Geuns RJ, de Jaegere PJ, Serruys PW, Krestin GP, de Feyter PJ.
    J Am Coll Cardiol. 2008 Aug 19;52(8):636-43.
    PMID:

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