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Rasmussen LD, Murphy T, Milidonis X, Eftekhari A, Karim SR, Westra J, Dahl JN, Isaksen C, Brix L, Ejlersen JA, Nyegaard M, Johansen JK, Søndergaard HM, Mortensen J, Gormsen LC, Christiansen EH, Chiribiri A, Petersen SE, Bøttcher M, Winther S. Myocardial Blood Flow by Magnetic Resonance in Patients With Suspected Coronary Stenosis: Comparison to PET and Invasive Physiology. Circ Cardiovasc Imaging 2024; 17:e016635. [PMID: 38889213 DOI: 10.1161/circimaging.124.016635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024]
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.
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Affiliation(s)
- Laust Dupont Rasmussen
- Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark
- Department of Cardiology, Aalborg University Hospital, Denmark (L.D.R.)
| | - Theodore Murphy
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (T.M., S.E.P.)
| | - Xenios Milidonis
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (X.M., A.C.)
| | - Ashkan Eftekhari
- Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark
| | - Salma Raghad Karim
- Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark
| | - Jelmer Westra
- Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark
| | - Jonathan Nørtoft Dahl
- Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark
| | - Christin Isaksen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Denmark (C.I., L.B.)
| | - Lau Brix
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Denmark (C.I., L.B.)
| | | | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Denmark (M.N.)
| | - Jane Kirk Johansen
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark (J.K.J.)
| | | | - Jesper Mortensen
- Department of Nuclear Medicine (J.M.), Gødstrup Hospital, Herning, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET Centre (L.C.G.), Aarhus University Hospital, Denmark
| | | | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (X.M., A.C.)
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (T.M., S.E.P.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, United Kingdom (S.E.P.)
| | - Morten Bøttcher
- Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark
| | - Simon Winther
- Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark
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Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, Mantini C, Zimarino M, Fedorowski A, Gallina S, Petersen SE, Bucciarelli-Ducci C. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:662-673. [PMID: 37285143 PMCID: PMC10248816 DOI: 10.1001/jamacardio.2023.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Importance The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. Data Sources PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Study Selection Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. Data Extraction and Synthesis This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Main Outcomes and Measures Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. Results A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. Conclusion and Relevance In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Rimini Hospital, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Steffen E. Petersen
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
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Fu R, Song C, Yang J, Gao C, Wang Y, Xu H, Gao X, Fan X, Xu H, Wang H, Dou K, Yang Y. A Practical Risk Score to Predict 24-Month Post-Discharge Mortality Risk in Patients With Non-ST-Segment Elevation Myocardial Infarction. Circ J 2020; 84:1974-1980. [PMID: 32938900 DOI: 10.1253/circj.cj-20-0509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Risk stratification of patients with non-ST-segment elevation myocardial infarction (NSTEMI) is important in terms of treatment strategy selection. Current efforts have focused on short-term risk prediction after discharge, but we aimed to establish a risk score to predict the 24-month mortality risk in survivors of NSTEMI.Methods and Results:A total of 5,509 patients diagnosed with NSTEMI between January 2013 and September 2014 were included. Primary endpoint was all-cause death at 24 months. A multivariable Cox regression model was used to establish a practical risk score based on independent risk factors of death. The risk score included 9 variables: age, body mass index, left ventricular ejection fraction, reperfusion therapy during hospitalization, Killip classification, prescription of diuretics at discharge, heart rate, and hemoglobin and creatinine levels. The C-statistics for the risk model were 0.83 (95% confidence interval [CI]: 0.81-0.85) and 0.83 (95% CI: 0.79-0.86) in the development and validation cohorts, respectively. Mortality risk increased significantly across groups: 1.34% in the low-risk group (score: 0-58), 5.40% in intermediate group (score: 59-93), and 23.87% in high-risk group (score: ≥94). CONCLUSIONS The current study established and validated a practical risk score based on 9 variables to predict 24-month mortality risk in patients who survive NSTEMI. This score could help identify patients who are at high risk for future adverse events who may benefit from good adherence to guideline-recommended secondary prevention treatment.
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Affiliation(s)
- Rui Fu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Chenxi Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Jingang Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Chuanyu Gao
- Department of Cardiology, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University
| | - Yan Wang
- Xiamen Cardiovascular Hospital Xiamen University
| | - Haiyan Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Xiaojin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Xiaoxue Fan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Han Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Hao Wang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Kefei Dou
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College
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Ullah W, Roomi S, Abdullah HM, Mukhtar M, Ali Z, Ye P, Haas DC, Figueredo VM. Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis. Cardiol Res 2020; 11:145-154. [PMID: 32494324 PMCID: PMC7239594 DOI: 10.14740/cr1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR. Methods Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (RevMan) 5.3 and Stata software. Results A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on the FFR thresholds, higher sensitivity and specificity (both 90%) were noted with the higher cutoff (0.75) and lower cutoff (0.8), respectively. At the vessel level, sensitivity and specificity at the lower FFR threshold were significantly higher at 88% and 89%, compared to the corresponding values for higher cutoff at 0.75. Similarly, meta-regression analysis of SCMR at higher (3T) resolution showed a higher sensitivity of 87% at the patient level and higher specificity of 90% at the vessel level. The highest sensitivity and specificity of SCMR (92% and 94%, respectively) were noted in studies with CAD prevalence greater than 60%. Conclusions SCMR has high diagnostic accuracy for CAD comparable to FFR at a spatial resolution of 3T and an FFR cut-off of 0.80. An increase in CAD prevalence further improved the specificity of SCMR.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Hafez M Abdullah
- Internal Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Maryam Mukhtar
- Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Zain Ali
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Ping Ye
- Internal Medicine, University of South Dakota, Sioux Falls, SD, USA.,Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Donald C Haas
- Abington Hospital-Jefferson Health, Abington, PA, USA
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Buckert D, Witzel S, Steinacker JM, Rottbauer W, Bernhardt P. Comparing Cardiac Magnetic Resonance-Guided Versus Angiography-Guided Treatment of Patients With Stable Coronary Artery Disease: Results From a Prospective Randomized Controlled Trial. JACC Cardiovasc Imaging 2019; 11:987-996. [PMID: 29976305 DOI: 10.1016/j.jcmg.2018.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was the prospective and randomized evaluation of cardiovascular endpoints and quality of life in patients with stable coronary artery disease comparing a cardiac magnetic resonance (CMR)-based management strategy with a coronary angiography-based approach. BACKGROUND Evidence from trials prospectively evaluating the role of CMR in clinical pathways and decision processes is limited. METHODS Patients with symptomatic CAD were randomized to diagnostic coronary angiography (group 1) or adenosine stress CMR (group 2). The primary endpoint was the composite of cardiac death and nonfatal myocardial infarction. Quality of life was assessed using the Seattle Angina Questionnaire at baseline and during follow-up. RESULTS Two hundred patients were enrolled. In group 1, 45 revascularizations (45.9%) were performed. In group 2, 27 patients (28.1%) were referred to revascularization because of ischemia on CMR. At 12-month follow-up, 7 primary events occurred: 3 in group 1 (event rate 3.1%) and 4 in group 2 (event rate 4.2%), with no statistically significant difference (p = 0.72). Within the next 2 years, 6 additional events could be observed, giving 4 events in group 1 and 9 events in group 2 (event rate 4.1% vs. 9.4%; p = 0.25). Group 2 showed significant quality-of-life improvement after 1 year in comparison to group 1. CONCLUSIONS A CMR-based management strategy for patients with stable coronary artery disease was safe, reduced revascularization procedures, and resulted in better quality of life at 12-month follow-up, though noninferiority could not be proved. Optimal timing for reassessment remains to be investigated. (Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary Intervention [MAGnet]; NCT02580851).
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Affiliation(s)
- Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Ulm, Germany.
| | - Simon Witzel
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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Comparison of diagnostic accuracy of stress myocardial perfusion imaging for detecting hemodynamically significant coronary artery disease between cardiac magnetic resonance and nuclear medical imaging: A meta-analysis. Int J Cardiol 2019; 293:278-285. [PMID: 31303392 DOI: 10.1016/j.ijcard.2019.06.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
Abstract
AIMS This study aimed to compare the diagnostic accuracy of stress myocardial perfusion imaging between cardiac magnetic resonance (CMR) and nuclear medical imaging, including single-photon emission computed tomography (SPECT) and positron emission tomography (PET), for the diagnosis of hemodynamically significant coronary artery disease (CAD) with fractional flow reserve (FFR) as the reference standard. METHODS AND RESULTS We searched PubMed and Embase for all published studies that evaluated the diagnostic accuracy of stress myocardial perfusion imaging modalities, including CMR, SPECT, and PET, to diagnose hemodynamically significant CAD with FFR as the reference standard. A total of 28 articles met the inclusion criteria and were included in the meta-analysis: 14 CMR, 13 SPECT, and 5 PET articles. The results demonstrated a pooled sensitivity of 0.88 (95% confidence interval [CI]: 0.80-0.93), 0.69 (95% CI: 0.56-0.79), and 0.83 (95% CI: 0.70-0.91), and a pooled specificity of 0.89 (95% CI: 0.85-0.93), 0.85 (95% CI, 0.80-0.89), and 0.89 (95% CI, 0.86-0.91) for CMR, SPECT, and PET, respectively. The area under the curve (AUC) of CMR, PET, and SPECT was 0.94 (95% CI, 0.92-0.96), 0.92 (95% CI, 0.89-0.94), and 0.87 (95% CI, 0.83-0.89), respectively. CONCLUSIONS CMR and PET both have high accuracy and SPECT has moderate accuracy to detect hemodynamically significant CAD with FFR as the reference standard. Furthermore, the diagnostic accuracy of CMR at 3.0 T is superior to 1.5 T.
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Villa ADM, Corsinovi L, Ntalas I, Milidonis X, Scannell C, Di Giovine G, Child N, Ferreira C, Nazir MS, Karady J, Eshja E, De Francesco V, Bettencourt N, Schuster A, Ismail TF, Razavi R, Chiribiri A. Importance of operator training and rest perfusion on the diagnostic accuracy of stress perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2018; 20:74. [PMID: 30454074 PMCID: PMC6245890 DOI: 10.1186/s12968-018-0493-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/09/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Clinical evaluation of stress perfusion cardiovascular magnetic resonance (CMR) is currently based on visual assessment and has shown high diagnostic accuracy in previous clinical trials, when performed by expert readers or core laboratories. However, these results may not be generalizable to clinical practice, particularly when less experienced readers are concerned. Other factors, such as the level of training, the extent of ischemia, and image quality could affect the diagnostic accuracy. Moreover, the role of rest images has not been clarified. The aim of this study was to assess the diagnostic accuracy of visual assessment for operators with different levels of training and the additional value of rest perfusion imaging, and to compare visual assessment and automated quantitative analysis in the assessment of coronary artery disease (CAD). METHODS We evaluated 53 patients with known or suspected CAD referred for stress-perfusion CMR. Nine operators (equally divided in 3 levels of competency) blindly reviewed each case twice with a 2-week interval, in a randomised order, with and without rest images. Semi-automated Fermi deconvolution was used for quantitative analysis and estimation of myocardial perfusion reserve as the ratio of stress to rest perfusion estimates. RESULTS Level-3 operators correctly identified significant CAD in 83.6% of the cases. This percentage dropped to 65.7% for Level-2 operators and to 55.7% for Level-1 operators (p < 0.001). Quantitative analysis correctly identified CAD in 86.3% of the cases and was non-inferior to expert readers (p = 0.56). When rest images were available, a significantly higher level of confidence was reported (p = 0.022), but no significant differences in diagnostic accuracy were measured (p = 0.34). CONCLUSIONS Our study demonstrates that the level of training is the main determinant of the diagnostic accuracy in the identification of CAD. Level-3 operators performed at levels comparable with the results from clinical trials. Rest images did not significantly improve diagnostic accuracy, but contributed to higher confidence in the results. Automated quantitative analysis performed similarly to level-3 operators. This is of increasing relevance as recent technical advances in image reconstruction and analysis techniques are likely to permit the clinical translation of robust and fully automated quantitative analysis into routine clinical practice.
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Affiliation(s)
- Adriana D. M. Villa
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Laura Corsinovi
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Cardiology Department of the Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Ioannis Ntalas
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Cardiology Department, St. Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Xenios Milidonis
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Cian Scannell
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Gabriella Di Giovine
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Nicholas Child
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | | | - Muhummad Sohaib Nazir
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Julia Karady
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | | | - Viola De Francesco
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Nuno Bettencourt
- Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreas Schuster
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tevfik F. Ismail
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
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van Dijk R, van Assen M, Vliegenthart R, de Bock GH, van der Harst P, Oudkerk M. Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis. J Cardiovasc Magn Reson 2017; 19:92. [PMID: 29178905 PMCID: PMC5702972 DOI: 10.1186/s12968-017-0393-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. METHOD Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the 'Quality Assessment of Diagnostic Accuracy Studies Tool' (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. RESULTS Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory analysis our results show similar diagnostic accuracy comparing anatomical (AUC 0.86(0.83-0.89)) and functional reference standards (AUC 0.88(0.84-0.90)). Only the per territory analysis sensitivity did not show significant heterogeneity. None of the groups showed signs of publication bias. CONCLUSIONS The clinical value of semi-quantitative and quantitative CMR perfusion analysis remains uncertain due to extensive inter-study heterogeneity and large differences in CMR perfusion acquisition protocols, reference standards, and methods of assessment of myocardial perfusion parameters. For wide spread implementation, standardization of CMR perfusion techniques is essential. TRIAL REGISTRATION CRD42016040176 .
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Affiliation(s)
- R. van Dijk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M. van Assen
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
| | - R. Vliegenthart
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G. H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P. van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M. Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
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Tesche C, De Cecco CN, Albrecht MH, Duguay TM, Bayer RR, Litwin SE, Steinberg DH, Schoepf UJ. Coronary CT Angiography–derived Fractional Flow Reserve. Radiology 2017; 285:17-33. [DOI: 10.1148/radiol.2017162641] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christian Tesche
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Carlo N. De Cecco
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Moritz H. Albrecht
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Taylor M. Duguay
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Richard R. Bayer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Sheldon E. Litwin
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Daniel H. Steinberg
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - U. Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., M.H.A., T.M.D., R.R.B., S.E.L., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., S.E.L., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
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Buckert D, Witzel S, Cieslik M, Tibi R, Rottbauer W, Bernhardt P. Magnetic resonance Adenosine perfusion imaging as Gatekeeper of invasive coronary intervention (MAGnet): study protocol for a randomized controlled trial. Trials 2017; 18:358. [PMID: 28754155 PMCID: PMC5534045 DOI: 10.1186/s13063-017-2101-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 07/12/2017] [Indexed: 01/19/2023] Open
Abstract
Background Current guidelines for the diagnosis and management of patients with stable coronary artery disease (CAD) recommend functional stress testing for risk stratification prior to revascularization procedures. Cardiac magnetic resonance imaging (CMR) is a modality of choice for stress testing because of its capability to detect myocardial ischemia sensitively and specifically. Nevertheless, evidence from randomized trials evaluating a CMR-based management of stable CAD patients in comparison to a more common angiography-based approach still is limited. Methods/design Patients presenting themselves with symptoms indicating a stable CAD and a class I or IIa indication for diagnostic coronary angiography are prospectively screened and enrolled in the study. All subjects receive a basic cardiological work-up and guideline-directed medical therapy. A 1:1 randomization in two groups is being performed. Patients in group 1 undergo diagnostic coronary angiography and subsequent revascularization according to current guidelines. Subjects in group 2 undergo adenosine stress CMR and in case of myocardial ischemia are sent to coronary angiography. Follow-up is planned for 3 years. During this time, the number of primary endpoints (defined as cardiac death and non-fatal myocardial infarction) and unplanned invasive procedures will be documented. Furthermore, symptom burden and quality of life will be assessed by use of the Seattle Angina Questionnaire. Sample size is calculated to prove non-inferiority of the CMR-based approach. Discussion In case this study is able to accomplish its aim to prove non-inferiority of the CMR-based management in patients with stable CAD; the importance of this emerging modality may further increase. Trial registration ClinicalTrials.gov, identifier: NCT02580851. Registered on 14 October 2015. Unique Protocol ID: 237/11 Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2101-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Simon Witzel
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Maciej Cieslik
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Raid Tibi
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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11
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Foley JRJ, Plein S, Greenwood JP. Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques. World J Cardiol 2017; 9:92-108. [PMID: 28289524 PMCID: PMC5329750 DOI: 10.4330/wjc.v9.i2.92] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/15/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023] Open
Abstract
Coronary artery disease (CAD) is a leading cause of death and disability worldwide. Cardiovascular magnetic resonance (CMR) is established in clinical practice guidelines with a growing evidence base supporting its use to aid the diagnosis and management of patients with suspected or established CAD. CMR is a multi-parametric imaging modality that yields high spatial resolution images that can be acquired in any plane for the assessment of global and regional cardiac function, myocardial perfusion and viability, tissue characterisation and coronary artery anatomy, all within a single study protocol and without exposure to ionising radiation. Advances in technology and acquisition techniques continue to progress the utility of CMR across a wide spectrum of cardiovascular disease, and the publication of large scale clinical trials continues to strengthen the role of CMR in daily cardiology practice. This article aims to review current practice and explore the future directions of multi-parametric CMR imaging in the investigation of stable CAD.
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12
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Lurz P, Luecke C, Eitel I, Föhrenbach F, Frank C, Grothoff M, de Waha S, Rommel KP, Lurz JA, Klingel K, Kandolf R, Schuler G, Thiele H, Gutberlet M. Comprehensive Cardiac Magnetic Resonance Imaging in Patients With Suspected Myocarditis: The MyoRacer-Trial. J Am Coll Cardiol 2016; 67:1800-1811. [PMID: 27081020 DOI: 10.1016/j.jacc.2016.02.013] [Citation(s) in RCA: 277] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data suggest that T1 and T2 mapping have excellent diagnostic accuracy in patients with suspected myocarditis. However, the true diagnostic performance of comprehensive cardiac magnetic resonance (CMR) mapping versus endomyocardial biopsy (EMB) has not been determined. OBJECTIVES This study assessed the performance of CMR imaging, including T1 and T2 mapping, compared with EMB in an unselected, consecutive patient cohort with suspected myocarditis. It also examined the potential role of CMR field strength by comparing 1.5-T versus 3.0-T imaging. METHODS Patients underwent biventricular EMB, cardiac catheterization (for exclusion of coronary artery disease), and CMR imaging on 1.5- and 3-T scanners. The CMR protocol included current standard Lake Louise criteria (LLC) for myocarditis as well as native T1, calculation of extracellular volume fraction (ECV), and T2 mapping (only on 1.5-T). Patients were divided into 2 groups according to symptom duration (acute: ≤14 days vs. chronic: >14 days). RESULTS A total of 129 patients underwent 1.5-T imaging. In patients with acute symptoms, native T1 yielded the best diagnostic performance as defined by the area under the curve (AUC) of receiver-operating curves (0.82) followed by T2 (0.81), ECV (0.75), and LLC (0.56). In patients with chronic symptoms, only T2 mapping yielded an acceptable AUC (0.77). On 3.0-T, AUCs of native T1, ECV, and LLC were comparable to 1.5-T with no significant differences. CONCLUSIONS In patients with acute symptoms, mapping techniques provide a useful tool for confirming or rejecting the diagnosis of myocarditis and are superior to the LLC. However, only T2 mapping has acceptable diagnostic performance in patients with chronic symptoms. (Magnetic Resonance Imaging in Myocarditis [MyoRacer]; NCT02177630).
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Affiliation(s)
- Philipp Lurz
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
| | - Christian Luecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Luebeck, University of Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Luebeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Felix Föhrenbach
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Clara Frank
- Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Suzanne de Waha
- University Heart Center Luebeck, University of Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Luebeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Julia Anna Lurz
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Karin Klingel
- Department of Molecular Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Reinhard Kandolf
- Department of Molecular Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Gerhard Schuler
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Holger Thiele
- University Heart Center Luebeck, University of Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Luebeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
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Jiang B, Cai W, Lv X, Liu H. Diagnostic Performance and Clinical Utility of Myocardial Perfusion MRI for Coronary Artery Disease with Fractional Flow Reserve as the Standard Reference: A Meta-analysis. Heart Lung Circ 2016; 25:1031-8. [PMID: 27108100 DOI: 10.1016/j.hlc.2016.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating haemodynamically significant coronary artery disease. We aimed to systematically analyse the diagnostic performance and clinical utility of myocardial perfusion MRI for coronary artery disease (CAD) using fractional flow reserve (FFR) as the standard reference. METHODS We searched PubMed, EMBASE, and Cochrane Library to July 2015 for studies using perfusion MR as a diagnostic test for CAD versus FFR. The meta-analysis was performed based on Cochrane guideline. RESULTS We identified 20 studies with 1,570 patients. Pooled analyses were performed at per-patient level (1,041 patients) and per-territory level (2,690 coronary territories). The sensitivity, specificity, area under sROC curve were 0.88 (95% CI: 0.85, 0.91), 0.88 (95% CI: 0.84, 0.90), and 0.94 (95% CI: 0.92, 0.96) at per-patient level, and 0.86 (95% CI: 0.81, 0.90), 0.88 (95% CI: 0.84, 0.92), and 0.93 (95% CI: 0.91, 0.95) at per-territory level. Post-test probability was altered by positive (likelihood ratio) LR of 7.1 (95% CI: 5.6, 9.0) and negative LR of 0.13 (95% CI: 0.10, 0.17) based on Bayes' theorem. CONCLUSIONS Diagnostic accuracy of myocardial perfusion MRI for CAD is high and can alter the post-test probability of CAD.
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Affiliation(s)
- Binghu Jiang
- Department of Radiology, Sir Yifu Hospital Affiliated with Nanjing Medical University, China
| | - Wei Cai
- Department of Cardiology, BenQ Medical Center, Nanjing Medical University, China
| | - Xianjun Lv
- Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, China
| | - Huaijun Liu
- Department of Radiology, the Second Hospital of Hebei Medical University, China.
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14
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Cardiovascular magnetic resonance for the assessment of coronary artery disease. Int J Cardiol 2015; 193:84-92. [DOI: 10.1016/j.ijcard.2014.11.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 10/13/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022]
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Improvement of regional and global left ventricular function in magnetic resonance imaging after recanalization of true coronary chronic total occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:228-32. [DOI: 10.1016/j.carrev.2015.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 11/23/2022]
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Nørgaard BL, Jensen JM, Leipsic J. Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing? Eur Radiol 2015; 25:2282-90. [DOI: 10.1007/s00330-015-3619-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/07/2015] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
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Doesch C, Papavassiliu T. Diagnosis and management of ischemic cardiomyopathy: Role of cardiovascular magnetic resonance imaging. World J Cardiol 2014; 6:1166-1174. [PMID: 25429329 PMCID: PMC4244614 DOI: 10.4330/wjc.v6.i11.1166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/02/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease (CAD) represents an important cause of mortality. Cardiovascular magnetic resonance (CMR) imaging evolved as an imaging modality that allows the assessment of myocardial function, perfusion, contractile reserve and extent of fibrosis in a single comprehensive exam. This review highlights the role of CMR in the differential diagnosis of acute chest pain by detecting the location of obstructive CAD or necrosis and identifying other conditions like stress cardiomyopathy or myocarditis that can present with acute chest pain. Besides, it underlines the prognostic implication of perfusion abnormalities in the setting of acute chest pain. Furthermore, the review addresses the role of CMR to detect significant CAD in patients with stable CAD. It elucidates the accuracy and clinical utility of CMR with respect to other imaging modalities like single-photon emission computed tomography and positron emission tomography. Besides, the prognostic value of CMR stress testing is discussed. Additionally, it summarizes the available CMR techniques to assess myocardial viability and describes algorithm to identify those patient who might profit from revascularization those who should be treated medically. Finally, future promising imaging techniques that will provide further insights into the fundamental disease processes in ischemic cardiomyopathy are discussed.
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Li M, Zhou T, Yang LF, Peng ZH, Ding J, Sun G. Diagnostic accuracy of myocardial magnetic resonance perfusion to diagnose ischemic stenosis with fractional flow reserve as reference: systematic review and meta-analysis. JACC Cardiovasc Imaging 2014; 7:1098-105. [PMID: 25306540 DOI: 10.1016/j.jcmg.2014.07.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/19/2014] [Accepted: 07/11/2014] [Indexed: 02/09/2023]
Abstract
OBJECTIVES This paper systematically analyzed the performance of magnetic resonance (MR) perfusion to diagnose coronary artery disease (CAD) with fractional flow reserve (FFR) as the reference standard. BACKGROUND Myocardial MR perfusion has passed the stage of a research technique and has demonstrated the ability to detect functional or ischemic stenosis of coronary arteries. However, the evidence is limited to single-center studies and small sample sizes. METHODS We searched PubMed and Embase databases for all published studies that evaluated the accuracy of MR perfusion to diagnose CAD versus FFR. We used an exact binomial rendition of the bivariate mixed-effects regression model with test type as a random-effects covariate to synthesize the available data. Based on Bayes' theorem, the post-test probability was calculated to guide MR perfusion's clinical utility. RESULTS We identified 14 studies evaluating 1,073 arteries and 650 patients. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI]: 0.86 to 0.93) and 0.87 (95% CI: 0.82 to 0.90) at the patient level and 0.89 (95% CI: 0.83 to 0.92) and 0.86 (95% CI: 0.77 to 0.92) at the artery and territory levels, respectively. The area under the summary receiver-operating characteristic at the patient level was 0.95 (95% CI: 0.92 to 0.96) and 0.93 (95% CI: 0.91 to 0.95) at the artery and territory levels, respectively. MR perfusion could increase the post-test probability of CAD >80% in patients with a pre-test probability of >37% and can decrease post-test probability of CAD <20% with a pre-test probability of <72%. CONCLUSIONS With FFR as the reference standard, the diagnostic ability of MR perfusion to detect ischemic CAD is high.
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Affiliation(s)
- Min Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Tao Zhou
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Lin-feng Yang
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Zhao-hui Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Juan Ding
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
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Salerno M, Kramer CM. Advances in parametric mapping with CMR imaging. JACC Cardiovasc Imaging 2014; 6:806-22. [PMID: 23845576 DOI: 10.1016/j.jcmg.2013.05.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 01/03/2023]
Abstract
Cardiac magnetic resonance imaging (CMR) is well established and considered the gold standard for assessing myocardial volumes and function, and for quantifying myocardial fibrosis in both ischemic and nonischemic heart disease. Recent developments in CMR imaging techniques are enabling clinically-feasible rapid parametric mapping of myocardial perfusion and magnetic relaxation properties (T1, T2, and T2* relaxation times) that are further expanding the range of unique tissue parameters that can be assessed using CMR. To generate a parametric map of perfusion or relaxation times, multiple images of the same region of the myocardium are acquired with different sensitivity to the parameter of interest, and the signal intensities of these images are fit to a model which describes the underlying physiology or relaxation parameters. The parametric map is an image of the fitted perfusion parameters or relaxation times. Parametric mapping requires acquisition of multiple images typically within a breath-hold and thus requires specialized rapid acquisition techniques. Quantitative perfusion imaging techniques can more accurately determine the extent of myocardial ischemia in coronary artery disease and provide the opportunity to evaluate microvascular disease with CMR. T1 mapping techniques performed both with and without contrast are enabling quantification of diffuse myocardial fibrosis and myocardial infiltration. Myocardial edema and inflammation can be evaluated using T2 mapping techniques. T2* mapping provides an assessment of myocardial iron-overload and myocardial hemorrhage. There is a growing body of evidence for the clinical utility of quantitative assessment of perfusion and relaxation times, although current techniques still have some important limitations. This article will review the current imaging technologies for parametric mapping, emerging applications, current limitations, and potential of CMR parametric mapping of the myocardium. The specific focus will be the assessment and quantification of myocardial perfusion and magnetic relaxation times.
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Affiliation(s)
- Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Paul Taggart D, van der Wall EE, Vrints CJ, Luis Zamorano J, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Anton Sirnes P, Luis Tamargo J, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, González-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Dalby Kristensen S, Lancellotti P, Pietro Maggioni A, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Anton Sirnes P, Gabriel Steg P, Timmis A, Wijns W, Windecker S, Yildirir A, Luis Zamorano J. Guía de Práctica Clínica de la ESC 2013 sobre diagnóstico y tratamiento de la cardiopatía isquémica estable. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJM, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34:2949-3003. [PMID: 23996286 DOI: 10.1093/eurheartj/eht296] [Citation(s) in RCA: 2906] [Impact Index Per Article: 264.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Desai RR, Jha S. Diagnostic Performance of Cardiac Stress Perfusion MRI in the Detection of Coronary Artery Disease Using Fractional Flow Reserve as the Reference Standard: A Meta-Analysis. AJR Am J Roentgenol 2013; 201:W245-W252. [DOI: 10.2214/ajr.12.10002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Ravi R. Desai
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 8227 Beacon Pl, Cleveland, OH 44103
| | - Saurabh Jha
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
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Comparison of MR and CT for the Assessment of the Significance of Coronary Artery Disease: a Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9186-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ikuye K, Buckert D, Schaaf L, Walcher T, Rottbauer W, Bernhardt P. Inter-observer agreement and diagnostic accuracy of myocardial perfusion reserve quantification by cardiovascular magnetic resonance at 3 Tesla in comparison to quantitative coronary angiography. J Cardiovasc Magn Reson 2013; 15:25. [PMID: 23537061 PMCID: PMC3707831 DOI: 10.1186/1532-429x-15-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/28/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Quantification of cardiovascular magnetic resonance (CMR) myocardial perfusion reserve (MPR) at 1.5 Tesla has been shown to correlate to invasive evaluation of coronary artery disease (CAD) and to yield good inter-observer agreement. However, little is known about quantitative adenosine-perfusion CMR at 3 Tesla and no data about inter-observer agreement is available. Aim of our study was to evaluate inter-observer agreement and to assess the diagnostic accuracy in comparison to quantitative coronary angiography (QCA). METHODS Fifty-three patients referred for coronary x-ray angiography were previously examined in a 3 Tesla whole-body scanner. Adenosine and rest perfusion CMR were acquired for the quantification of MPR in all segments. Two blinded and independent readers analyzed all images. QCA was performed in case of coronary stenosis. QCA data was used to assess diagnostic accuracy of the MPR measurements. RESULTS Inter-observer agreement was high for all myocardial perfusion territories (ρ = 0.92 for LAD, ρ = 0.93 for CX and RCA perfused segments). Compared to QCA receiver-operating characteristics yielded an area under the curve of 0.78 and 0.73 for RCA, 0.66 and 0.69 for LAD, and 0.52 and 0.53 for LCX perfused territories. CONCLUSIONS Inter-observer agreement of MPR quantification at 3 Tesla CMR is very high for all myocardial segments. Diagnostic accuracy in comparison to QCA yields good values for the RCA and LAD perfused territories, but moderate values for the posterior LCX perfused myocardial segments.
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Affiliation(s)
- Katharina Ikuye
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Lisa Schaaf
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Thomas Walcher
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Peter Bernhardt
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
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Abstract
The haemodynamic effect of a coronary artery stenosis is a better predictor of prognosis than anatomical lumen obstruction. Until recently, no individual non-invasive test could provide both accurate coronary anatomy and lesion-specific myocardial ischaemia. However, computer tomography (CT) fractional flow reserve, which can be calculated from a standard CT coronary angiogram, was recently demonstrated to accurately detect and rule out the haemodynamic significance of individual coronary artery stenoses.
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Is contrast-enhanced cardiac magnetic resonance imaging at 3 T superior to 1.5 T for detection of coronary artery disease? Int J Cardiovasc Imaging 2012; 29:355-61. [DOI: 10.1007/s10554-012-0099-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/09/2012] [Indexed: 10/28/2022]
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