Data on diagnostic performance of stress perfusion cardiac magnetic resonance for coronary artery disease detection at the vessel level

Clinical assessment of adenosine stress and rest cardiac magnetic resonance T1 mapping for detecting ischemic and infarcted myocardium

Cardiac magnetic resonance (CMR) spin-lattice relaxation time (T1) may be influenced by pathologic conditions due to changes in myocardial water content. We aimed to validate the principle and investigate T1 mapping at rest and adenosine stress to differentiate ischemic and infarcted myocardium from controls. Patients with suspected coronary artery disease who underwent CMR were prospectively recruited. Native rest and adenosine stress T1 maps were obtained using standard modified Look-Locker Inversion-Recovery technique. Among 181 patients included, T1 values were measured from three groups. In the control group, 72 patients showed myocardium with a T1 profile of 1,039 ± 75 ms at rest and a significant increase during stress (4.79 ± 3.14%, p < 0.001). While the ischemic (51 patients) and infarcted (58 patients) groups showed elevated resting T1 compared to controls (1,040 ± 90 ms for ischemic; 1,239 ± 121 ms for infarcted, p < 0.001), neither of which presented significant T1 reactivity (1.38 ± 3.02% for ischemic; 1.55 ± 5.25% for infarcted). We concluded that adenosine stress and rest T1 mapping may be useful to differentiate normal, ischemic and infarcted myocardium.

Diagnostic performance of stress perfusion cardiac magnetic resonance for the detection of coronary artery disease: A systematic review and meta-analysis

INTRODUCTION

The purpose of this study was to investigate the accuracy of qualitative stress perfusion cardiac magnetic resonance (CMR) to diagnose ischemia-causing lesions according to different definitions of significant coronary artery disease (CAD), and magnetic field strength.

METHODS

We searched PubMed, Web of Science, and the Cochrane Library for studies evaluating diagnostic performance of qualitative stress perfusion CMR for diagnosis of CAD versus coronary angiography or fractional flow reserve (FFR) from inception to 10 September 2017. We used hierarchical models to synthesize the available data.

RESULTS

Sixty-seven studies (7113 patients) met the inclusion criteria. The patient-based analysis of studies using FFR as the reference standard demonstrated a mean sensitivity of 0.90 (95% confidence interval [CI], 0.85-0.93) and a mean specificity of 0.85 (95% CI, 0.80-0.89). The patient-based analyses for detecting coronary stenosis ≥50% and coronary stenosis ≥70% at 1.5T and for detecting coronary stenosis ≥50% and coronary stenosis ≥70%, at 3T, demonstrated a mean sensitivity of 0.82 (95% CI, 0.79-0.84), 0.86 (95% CI, 0.83-0.89), 0.90 (95% CI, 0.82-0.95), and 0.91 (95% CI, 0.79-0.96), respectively; with a mean specificity of 0.75 (95% CI, 0.71-0.80), 0.77 (95% CI, 0.71-0.81), 0.79 (95% CI, 0.69-0.86), and 0.74 (95% CI, 0.59-0.85).

CONCLUSION

Qualitative stress perfusion CMR has high accuracy for the diagnosis of CAD, irrespective of the reference standard and the magnet strength. Studies using FFR as the reference standard had higher diagnostic accuracy on a patient level compared to studies using coronary angiography, with a notable difference in specificity.