Abstract 10847: Validation of Three-dimensional Whole Heart Magnetic Resonance Myocardial Perfusion Imaging Against Fractional Flow Reserve for the Detection of Significant Coronary Heart Disease
Background: Three-dimensional (3D) myocardial perfusion cardiovascular magnetic resonance (CMR) has recently been proposed to overcome the limited spatial coverage of conventional perfusion CMR methods. The method has shown good diagnostic accuracy for the detection of coronary artery disease determined by quantitative coronary angiography. However only an approximate relationship exists between the severity of a coronary stenosis and its functional significance. Pressure wire-derived fractional flow reserve (FFR) <0.75 correlates more closely with objective evidence of reversible ischemia.
Objectives: To determine the diagnostic accuracy of whole heart 3D myocardial perfusion CMR against invasively determined FFR.
Methods: Thirty-eight patients with known or suspected coronary artery disease underwent rest and adenosine stress 3D myocardial perfusion CMR at 3Tesla (3D turbo gradient echo, 10 fold acceleration, flip angle 15, TR 2.0ms/TE 1.0ms, in-plane resolution 2.3x2.3mm2, 12 slices of 5mm thickness).
For 3D perfusion, a k-space and time sensitivity encoding accelerated method with compartment-based k-t principal component analysis was used. The FFR was measured in all vessels >50% severity stenosis. Fractional flow reserve <0.75 was considered hemodynamically significant. The CMR data was analysed by a blinded observer.
Results: Of 114 coronary vessels, 49 underwent pressure wire assessment. Of these, 33 lesions had an FFR<0.75. Sensitivity, specificity and diagnostic accuracy of CMR analysis by coronary territory was 88%, 85% and 86% respectively with a negative predictive value of 94%. Similarly the values were 93%, 80% and 90% when analyzed for each patient.
Conclusion: 3D CMR stress perfusion can detect functionally significant coronary artery disease with excellent sensitivity, specificity and negative predictive values when compared with FFR.
- © 2011 by American Heart Association, Inc.