Assessment of right and left ventricular perfusion in patients with right bundle branch block

High spatial resolution myocardial perfusion cardiac magnetic resonance for the detection of coronary artery disease

Aims

To evaluate the feasibility and diagnostic performance of high spatial resolution myocardial perfusion cardiac magnetic resonance (perfusion-CMR).

Methods and results

Fifty-four patients underwent adenosine stress perfusion-CMR. An in-plane spatial resolution of 1.4 × 1.4 mm² was achieved by using 5× k-space and time sensitivity encoding (k–t SENSE). Perfusion was visually graded for 16 left ventricular and two right ventricular (RV) segments on a scale from 0 = normal to 3 = abnormal, yielding a perfusion score of 0–54. Diagnostic accuracy of the perfusion score to detect coronary artery stenosis of >50% on quantitative coronary angiography was determined. Sources and extent of image artefacts were documented.

Two studies (4%) were non-diagnostic because of k–t SENSE-related and breathing artefacts. Endocardial dark rim artefacts if present were small (average width 1.6 mm). Analysis by receiver–operating characteristics yielded an area under the curve for detection of coronary stenosis of 0.85 [95% confidence interval (CI) 0.75–0.95] for all patients and 0.82 (95% CI 0.65–0.94) and 0.87 (95% CI 0.75–0.99) for patients with single and multi-vessel disease, respectively. Seventy-four of 102 (72%) RV segments could be analysed.

Conclusion

High spatial resolution perfusion-CMR is feasible in a clinical population, yields high accuracy to detect single and multi-vessel coronary artery disease, minimizes artefacts and may permit the assessment of RV perfusion.