Elsevier

JACC: Cardiovascular Imaging

Volume 13, Issue 12, December 2020, Pages 2546-2557
JACC: Cardiovascular Imaging

Original Research
Assessment of Multivessel Coronary Artery Disease Using Cardiovascular Magnetic Resonance Pixelwise Quantitative Perfusion Mapping

https://doi.org/10.1016/j.jcmg.2020.06.041Get rights and content
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Abstract

Objectives

The authors sought to compare the diagnostic accuracy of quantitative perfusion maps to visual assessment (VA) of first-pass perfusion images for the detection of multivessel coronary artery disease (MVCAD).

Background

VA of first-pass stress perfusion cardiac magnetic resonance (CMR) may underestimate ischemia in MVCAD. Pixelwise perfusion mapping allows quantitative measurement of regional myocardial blood flow, which may improve ischemia detection in MVCAD.

Methods

One hundred fifty-one subjects recruited at 2 centers underwent stress perfusion CMR with myocardial perfusion mapping, and invasive coronary angiography with coronary physiology assessment. Ischemic burden was assessed by VA of first-pass images and by quantitative measurement of stress myocardial blood flow using perfusion maps.

Results

In patients with MVCAD (2-vessel [2VD] or 3-vessel disease [3VD]; n = 95), perfusion mapping identified significantly more segments with perfusion defects (median segments per patient 12 [interquartile range (IQR): 9 to 16] by mapping vs. 8 [IQR: 5 to 9.5] by VA; p < 0.001). Ischemic burden (IB) measured using mapping was higher in MVCAD compared with IB measured using VA (3VD mapping 100 % (75% to 100%) vs. first-pass 56% (38% to 81%) ; 2VD mapping 63% (50% to 75%) vs. first-pass 41% (31% to 50%); both p < 0.001), but there was no difference in single-vessel disease (mapping 25% (13% to 44%) vs. 25% (13% to 31%). Perfusion mapping was superior to VA for the correct identification of extent of coronary disease (78% vs. 58%; p < 0.001) due to better identification of 3VD (87% vs. 40%) and 2VD (71% vs. 48%).

Conclusions

VA of first-pass stress perfusion underestimates ischemic burden in MVCAD. Pixelwise quantitative perfusion mapping increases the accuracy of CMR in correctly identifying extent of coronary disease. This has important implications for assessment of ischemia and therapeutic decision-making.

Key Words

adenosine stress
cardiovascular magnetic resonance
coronary artery disease
myocardial blood flow

Abbreviations and Acronyms

2VD
2-vessel disease
3VD
3-vessel disease
AUC
area under the curve
CAD
coronary artery disease
CMR
cardiac magnetic resonance
CTO
chronic total occlusion
FFR
fractional flow reserve
IB
ischemic burden
MBF
myocardial blood flow
MVCAD
multivessel coronary artery disease
PCI
percutaneous coronary intervention
PET
positron-emission tomography
PMBFR
pixelwise myocardial blood flow reduction
VA
visual assessment

Cited by (0)

This study was supported by the National Amyloidosis Centre, University College London and the National Institute for Health Research University College London Hospitals Biomedical Research Centre.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.