Do we need invasive confirmation of cardiac magnetic resonance results?

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Techniques

Background:

• Coronary artery revascularization is crucial for patients with significant coronary artery obstruction and myocardial ischemia or untreatable symptoms.
• Assessing the functional significance of coronary artery narrowing often requires multiple invasive or noninvasive methods, especially for atypical symptoms or borderline stenosis.
• Revascularization decisions necessitate reliable methods to evaluate coronary blood flow and myocardial ischemia.

Purpose of the Study:

• To determine if cardiac magnetic resonance (CMR) findings for coronary artery stenosis require confirmation by invasive functional testing.
• To evaluate the diagnostic accuracy of CMR perfusion in detecting hemodynamically significant coronary artery disease (CAD).

Main Methods:

• A retrospective analysis of 25 patients with 29 stenoses who underwent both CMR and fractional flow reserve (FFR) between 2010 and 2014.
• Maximal time interval between CMR and FFR assessments was limited to 6 months.
• Patients were monitored for clinical events or interventions between the diagnostic procedures.

Main Results:

• Cardiac magnetic resonance (CMR) perfusion demonstrated an 89.7% agreement with the fractional flow reserve (FFR) method.
• The sensitivity of CMR perfusion for detecting significant stenoses, using FFR as the gold standard, was 90.9%.
• CMR correctly identified 88.9% of non-severe lesions.

Conclusions:

• CMR perfusion is a highly sensitive non-invasive tool for detecting hemodynamically significant CAD.
• The diagnostic accuracy of MR perfusion is high in identifying ischemic CAD, comparable to the invasive FFR standard.
• CMR perfusion effectively excludes non-severe coronary artery lesions, potentially streamlining patient management.