Myocardial Blood Flow by Magnetic Resonance in Patients With Suspected Coronary Stenosis: Comparison to PET and Invasive Physiology. (2024)

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• Rasmussen LD; Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark.
• Murphy T; Department of Cardiology, Aalborg University Hospital, Denmark (L.D.R.).
• Milidonis X; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (T.M., S.E.P.).
• Eftekhari A; Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (X.M., A.C.).
• Karim SR; Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark.
• Westra J; Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark.
• Dahl JN; Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark.
• Isaksen C; Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark.
• Brix L; Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Denmark (C.I., L.B.).
• Ejlersen JA; Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Denmark (C.I., L.B.).
• Nyegaard M; Department of Nuclear Medicine, Viborg Hospital, Denmark (J.A.E.).
• Johansen JK; Department of Health Science and Technology, Aalborg University, Denmark (M.N.).
• Søndergaard HM; Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark (J.K.J.).
• Mortensen J; Department of Cardiology, Regional Hospital Central Jutland, Viborg, Denmark (H.M.S.).
• Gormsen LC; Department of Nuclear Medicine (J.M.), Gødstrup Hospital, Herning, Denmark.
• Christiansen EH; Department of Nuclear Medicine and PET Centre (L.C.G.), Aarhus University Hospital, Denmark.
• Chiribiri A; Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark.
• Petersen SE; Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (X.M., A.C.).
• Bøttcher M; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (T.M., S.E.P.).
• Winther S; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, United Kingdom (S.E.P.).

ABSTRACT

BACKGROUND:

Despite recent guideline recommendations, quantitative perfusion (QP) estimates of myocardial blood flow from cardiac magnetic resonance (CMR) have only been sparsely validated. Furthermore, the additional diagnostic value of utilizing QP in addition to the traditional visual expert interpretation of stress-perfusion CMR remains unknown. The aim was to investigate the correlation between myocardial blood flow measurements estimated by CMR, positron emission tomography, and invasive coronary thermodilution. The second aim is to investigate the diagnostic performance of CMR-QP to identify obstructive coronary artery disease (CAD).

METHODS:

Prospectively enrolled symptomatic patients with >50% diameter stenosis on computed tomography angiography underwent dual-bolus CMR and positron emission tomography with rest and adenosine-stress myocardial blood flow measurements. Subsequently, an invasive coronary angiography (ICA) with fractional flow reserve and thermodilution-based coronary flow reserve was performed. Obstructive CAD was defined as both anatomically severe (>70% diameter stenosis on quantitative coronary angiography) or hemodynamically obstructive (ICA with fractional flow reserve ≤0.80).

RESULTS:

About 359 patients completed all investigations. Myocardial blood flow and reserve measurements correlated weakly between estimates from CMR-QP, positron emission tomography, and ICA-coronary flow reserve (r<0.40 for all comparisons). In the diagnosis of anatomically severe CAD, the interpretation of CMR-QP by an expert reader improved the sensitivity in comparison to visual analysis alone (82% versus 88% [P=0.03]) without compromising specificity (77% versus 74% [P=0.28]). In the diagnosis of hemodynamically obstructive CAD, the accuracy was only moderate for a visual expert read and remained unchanged when additional CMR-QP measurements were interpreted.

CONCLUSIONS:

CMR-QP correlates weakly to myocardial blood flow measurements by other modalities but improves diagnosis of anatomically severe CAD. REGISTRATION URL https//www.clinicaltrials.gov; Unique identifier NCT03481712.