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Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Perfusion dyssynchrony analysis
Amedeo Chiribiri1, Adriana D M Villa2, Eva Sammut2
1Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK amedeo.chiribiri@kcl.ac.uk.
Insights
Perfusion dyssynchrony analysis using stress cardiac magnetic resonance (CMR) effectively identifies coronary artery disease (CAD). This novel method analyzes contrast agent wash-in timing, offering a robust approach to assess myocardial perfusion and aid CAD diagnosis.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Cardiac MRI
Background:
- Coronary artery disease (CAD) diagnosis relies on assessing myocardial perfusion.
- High temporal resolution of stress perfusion CMR offers potential for novel analytical approaches.
Purpose of the Study:
- To describe and evaluate a novel perfusion dyssynchrony analysis for stress perfusion CMR.
- To detect differences in contrast agent wash-in timing across the left ventricular wall.
Main Methods:
- Retrospective analysis of 98 patients with suspected CAD undergoing 3T stress perfusion CMR and invasive angiography.
- Analysis of stress images using four perfusion dyssynchrony indices: V-TTMU, C-TTMU, V-TTP, and C-TTP.
- Correlation of indices with FFR-defined haemodynamically significant CAD and number of diseased vessels.
Main Results:
- All perfusion dyssynchrony indices identified significant CAD.
- C-TTP >10% showed high sensitivity (0.889) and specificity (0.857) for CAD.
- C-TTP >12% identified multi-vessel disease with sensitivity 0.806 and specificity 0.657.
- C-TTP demonstrated the best inter- and intra-observer reproducibility.
Conclusions:
- Perfusion dyssynchrony analysis is a robust novel method for first-pass perfusion assessment.
- This approach has the potential to provide complementary information for CAD assessment.
- The technique leverages the high temporal resolution of stress perfusion CMR.
Aims:
We sought to describe perfusion dyssynchrony analysis specifically to exploit the high temporal resolution of stress perfusion CMR. This novel approach detects differences in the temporal distribution of the wash-in of contrast agent across the left ventricular wall.
Methods And Results:
Ninety-eight patients with suspected coronary artery disease (CAD) were retrospectively identified. All patients had undergone perfusion CMR at 3T and invasive angiography with fractional flow reserve (FFR) of lesions visually judged >50% stenosis. Stress images were analysed using four different perfusion dyssynchrony indices: the variance and coefficient of variation of the time to maximum signal upslope (V-TTMU and C-TTMU) and the variance and coefficient of variation of the time to peak myocardial signal enhancement (V-TTP and C-TTP). Patients were classified according to the number of vessels with haemodynamically significant CAD indicated by FFR <0.8. All indices of perfusion dyssynchrony were capable of identifying the presence of significant CAD. C-TTP >10% identified CAD with sensitivity 0.889, specificity 0.857 (P < 0.0001). All indices correlated with the number of diseased vessels. C-TTP >12% identified multi-vessel disease with sensitivity 0.806, specificity 0.657 (P < 0.0001). C-TTP was also the dyssynchrony index with the best inter- and intra-observer reproducibility. Perfusion dyssynchrony indices showed weak correlation with other invasive and non-invasive measurements of the severity of ischaemia, including FFR, visual ischaemic burden, and MPR.
Conclusion:
These findings suggest that perfusion dyssynchrony analysis is a robust novel approach to the analysis of first-pass perfusion and has the potential to add complementary information to aid assessment of CAD.
