High-resolution free-breathing automated quantitative myocardial perfusion by cardiovascular magnetic resonance for the detection of functionally significant coronary artery disease

Crawley R, Kunze KP, Milidonis X, Highton J, McElroy S, Frey SM, Höfler D, Karamanli C, Wong NC, Backhaus SJ, Alskaf E, Neji R, Scannell CM, Plein S, Chiribiri A (2024)

Publication Type: Journal article

Publication year: 2024

Journal

European Heart Journal - Cardiovascular Imaging Oxford University Press

Book Volume: 25

Pages Range: 914-925

Journal Issue: 7

DOI: 10.1093/ehjci/jeae084

Abstract

Aims Current assessment of myocardial ischaemia from stress perfusion cardiovascular magnetic resonance (SP-CMR) largely relies on visual interpretation. This study investigated the use of high-resolution free-breathing SP-CMR with automated quantitative mapping in the diagnosis of coronary artery disease (CAD). Diagnostic performance was evaluated against invasive coronary angiography (ICA) with fractional flow reserve (FFR) measurement. Methods Seven hundred and three patients were recruited for SP-CMR using the research sequence at 3 Tesla. Of those receiving and results ICA within 6 months, 80 patients had either FFR measurement or identification of a chronic total occlusion (CTO) with inducible perfusion defects seen on SP-CMR. Myocardial blood flow (MBF) maps were automatically generated in-line on the scanner following image acquisition at hyperaemic stress and rest, allowing myocardial perfusion reserve (MPR) calculation. Seventy-five coronary vessels assessed by FFR and 28 vessels with CTO were evaluated at both segmental and coronary territory level. Coronary territory stress MBF and MPR were reduced in FFR-positive (≤0.80) regions [median stress MBF: 1.74 (0.90–2.17) mL/min/g; MPR: 1.67 (1.10–1.89)] compared with FFR-negative regions [stress MBF: 2.50 (2.15–2.95) mL/min/g; MPR 2.35 (2.06–2.54) P < 0.001 for both]. Stress MBF ≤ 1.94 mL/min/g and MPR ≤ 1.97 accurately detected FFR-positive CAD on a per-vessel basis (area under the curve: 0.85 and 0.96, respectively; P < 0.001 for both). Conclusion A novel scanner-integrated high-resolution free-breathing SP-CMR sequence with automated in-line perfusion mapping is presented which accurately detects functionally significant CAD.

Authors with CRIS profile

Daniel Höfler Department of Radiation Oncology

Involved external institutions

St Thomas' Hospital GB United Kingdom (GB) Universitätsspital Basel CH Switzerland (CH) Justus-Liebig-Universität Gießen DE Germany (DE)

How to cite

APA:

Crawley, R., Kunze, K.P., Milidonis, X., Highton, J., McElroy, S., Frey, S.M.,... Chiribiri, A. (2024). High-resolution free-breathing automated quantitative myocardial perfusion by cardiovascular magnetic resonance for the detection of functionally significant coronary artery disease. European Heart Journal - Cardiovascular Imaging, 25(7), 914-925. https://doi.org/10.1093/ehjci/jeae084

MLA:

Crawley, R., et al. "High-resolution free-breathing automated quantitative myocardial perfusion by cardiovascular magnetic resonance for the detection of functionally significant coronary artery disease." European Heart Journal - Cardiovascular Imaging 25.7 (2024): 914-925.

BibTeX: Download