Abstract 11418: Incremental Value of High-Resolution Myocardial Perfusion Cardiovascular Magnetic Resonance Imaging in Patients with Three-Vessel Coronary Artery Disease
Introduction The detection of three-vessel coronary artery disease (3VD) with non-invasive imaging can be challenging due to the effects of balanced ischemia. We hypothesised that high-resolution myocardial perfusion cardiac magnetic resonance (perfusion-CMR) would outperform standard-resolution acquisition for the detection of 3VD.
Methods Twenty-four patients with angiographic 3VD and 24 normal controls underwent stress perfusion-CMR (1.5T Philips Intera) with a standard-resolution method (2.5mm in-plane using two-fold sensitivity encoding - SENSE) and on a separate visit with a high-resolution method (1.3mm in-plane achieved with 8-fold k-t SENSE acceleration) - see figure 1. Two blinded observers visually interpreted the CMR data by grading perfusion in each segment on a 5-point scale (0 = normal; 4 = absent uptake) in a 16-segment model. Segmental scores were summed to produce a perfusion score (0-64) for each patient and a score of ≥4 was considered abnormal.
Results In the 3VD group, high-resolution perfusion-CMR identified more abnormal segments per patient (7.3 ± 3.7 vs. 5.2 ± 3.9; p=0.01), more abnormal territories per patient (2.0 ± 0.9 vs. 1.46 ± 1.0; p=0.02) and a higher overall perfusion score (17.7 ± 8.6 vs. 13.9 ± 10.2; p=0.03). The number of segments with subendocardial ischemia was greater for high-resolution CMR (134 vs. 70 segments; 47% vs. 24%; p <0.0001). On a per patient analysis, the sensitivity, specificity and area under the curve (AUC) for identifying any perfusion defect were similar for both methods (92%, 74% and 0.94 respectively for high-resolution and 79%, 84% and 0.87 for standard-resolution CMR; all p values > 0.05).
Conclusions In this small study, standard and high-resolution perfusion-CMR had similar diagnostic accuracies for identifying any perfusion abnormality in 3VD. However, high-resolution CMR increased the detection of disease burden by identifying a greater number of segments with subendocardial ischemia.
- © 2011 by American Heart Association, Inc.