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Published on: June 11, 2019
Ischemic burden by 3-dimensional myocardial perfusion cardiovascular magnetic resonance: comparison with myocardial
Roy Jogiya1, Geraint Morton1, Kalpa De Silva1
1From the King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Welcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, Division of Imaging Sciences, The Rayne Institute, London, United Kingdom (R.J., G.M., S.K., E.N., S.P.); King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, The Rayne Institute, London, United Kingdom (K.D.S.); Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom (E.R., S.R.U.); Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH (R.H.); Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (S.K.); and Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, United Kingdom (S.P.).
Insights
Three-dimensional (3D) myocardial perfusion cardiovascular magnetic resonance (CMR) accurately assesses ischemic burden in patients with coronary artery disease, offering an alternative to myocardial perfusion scintigraphy (MPS). This advanced CMR technique provides whole-heart coverage for comprehensive risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Myocardial perfusion scintigraphy (MPS) is standard for assessing ischemia in coronary artery disease.
- Conventional 2D cardiovascular magnetic resonance (CMR) perfusion imaging has limited cardiac coverage.
- 3D myocardial perfusion CMR offers complete heart coverage, improving ischemic burden assessment.
Purpose of the Study:
- To compare the accuracy of 3D myocardial perfusion CMR with MPS in quantifying ischemic burden.
- To evaluate the diagnostic performance of 3D myocardial perfusion CMR against invasive coronary angiography.
Main Methods:
- 45 patients with coronary artery disease underwent rest/stress 3D myocardial perfusion and late gadolinium enhancement CMR.
- Ischemic burden was calculated using a 17-segment model for both MPS and CMR.
- 33 patients underwent invasive coronary angiography for comparison.
Main Results:
- 3D myocardial perfusion CMR and MPS agreed on the detection of inducible ischemia in 38 of 45 patients.
- Mean ischemic burden was similar between MPS (7.5±8.9%) and CMR (6.8±9.5%), with strong correlation (rs=0.70).
- Sensitivities and specificities for detecting coronary artery disease were comparable between MPS and CMR.
Conclusions:
- 3D myocardial perfusion CMR is a viable alternative to MPS for ischemia detection and severity assessment.
- This advanced CMR technique provides comprehensive whole-heart coverage for improved risk stratification.
Background:
The extent and severity of ischemia on myocardial perfusion scintigraphy (MPS) is commonly used to risk-stratify patients with coronary artery disease. Estimation of ischemic burden by cardiovascular magnetic resonance (CMR) with conventional 2-dimensional myocardial perfusion methods is limited by incomplete cardiac coverage. More recently developed 3-dimensional (3D) myocardial perfusion CMR, however, provides whole-heart coverage. The aim of this study was to compare ischemic burden on 3D myocardial perfusion CMR with (99m)Tc-tetrofosmin MPS.
Methods And Results:
Forty-five patients who had undergone clinically indicated MPS underwent rest and adenosine stress 3D myocardial perfusion and late gadolinium enhancement CMR. Summed stress and rest scores were calculated for MPS and CMR using a 17-segment model and expressed as a percentage of the maximal possible score. Ischemic burden was defined as the difference between stress and rest scores. 3D myocardial perfusion CMR and MPS agreed in 38 of the 45 patients for the detection of any inducible ischemia. The mean ischemic burden for MPS and CMR was similar (7.5±8.9% versus 6.8±9.5%, respectively, P=0.82) with a strong correlation between techniques (rs=0.70, P<0.001). In a subset of 33 patients who underwent clinically indicated invasive coronary angiography, sensitivities and specificities of the 2 techniques to detect angiographic coronary artery disease were similar (McNemar P=0.45).
Conclusions:
3D myocardial perfusion CMR is an alternative to MPS for detecting the presence and rating the severity of ischemia.
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