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Correlation of FFR-derived from CT and stress perfusion CMR with invasive FFR in intermediate-grade coronary artery
Olivier Ghekiere1,2,3, Jurgen Bielen4, Jonathon Leipsic5
1Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, 4000, Liège, Belgium. olivier.ghekiere@jessazh.be.
Insights
Fractional flow reserve computed tomography (FFRCT) and adenosine perfusion cardiac magnetic resonance (CMR) accurately assess intermediate-grade coronary stenosis. Both non-invasive methods correlate strongly with invasive fractional flow reserve (FFR), aiding clinical decisions.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Intermediate-grade coronary artery stenosis (40-70% diameter narrowing) often requires further investigation to determine if it causes myocardial ischemia.
- Invasive fractional flow reserve (FFR) is the gold standard but necessitates invasive procedures.
Purpose of the Study:
- To evaluate the correlation between FFR estimates derived from computed tomography (FFRCT) and adenosine perfusion cardiac magnetic resonance (CMR) with invasive FFR in patients with intermediate-grade coronary stenosis.
Main Methods:
- Retrospective evaluation of 37 patients with intermediate-grade stenoses.
- Comparison of invasive FFR values with FFRCT and adenosine perfusion CMR (assessed via relative myocardial perfusion index).
Main Results:
- FFRCT (r=0.675, p<0.001) and relative myocardial perfusion index from CMR (r=-0.63, p<0.001) showed strong correlations with invasive FFR.
- Uncorrected perfusion upslopes showed poor correlation with invasive FFR (r=0.151, p=0.36).
Conclusions:
- Both FFRCT and adenosine perfusion CMR are strongly correlated with invasive FFR measurements for intermediate-grade coronary stenosis.
- These non-invasive methods show promise for evaluating intermediate coronary stenosis in clinical practice, potentially reducing the need for invasive procedures.
Abstract:
Only one-third of intermediate-grade coronary artery stenosis (i.e. 40-70% diameter narrowing) causes myocardial ischemia, requiring most often additional invasive work-up with invasive fractional flow reserve (FFR). To evaluate the correlations between FFR estimates derived from computed tomography (FFRCT) and adenosine perfusion cardiac magnetic resonance (CMR) with invasive FFR in intermediate-grade stenosis. Thirty-seven patients (mean age 61 ± 9 years; 25 men) who underwent adenosine perfusion CMR, quantitative coronary angiography and FFR in the work-up for intermediate-grade stenoses (n = 39) diagnosed at coronary CT angiography were retrospectively evaluated. Blinded FFRCT analysis was computed on each intermediate-grade lesion and correlated to the FFR values. On adenosine CMR, subendocardial time-enhancement maximal upslopes, normalized by respective left ventricle cavity upslopes, were obtained distal to a coronary stenosis (RISK area) and in remote myocardium (REMOTE area). The perfusion was subsequently assessed without (uncorrected RISK) and after correction for remote perfusion (relative myocardial perfusion index = REMOTE/RISK ratio), and then correlated to the FFR values. Differences in correlations were tested with z statistics and considered statistically significant different at a p < 0.05 level. The average FFR value was 0.85 ± 0.10 (0.60-0.98 range), 28% (n = 11) was ≤ 0.80. FFR value correlated poorly with uncorrected RISK upslopes (r = 0.151; p = 0.36), but equally strongly with FFRCT (r = 0.675; p < 0.001) and the relative myocardial perfusion index (r = - 0.63) (p < 0.001; z = 6.72) for assessment of lesion-specific ischemia. Both FFRCT and adenosine perfusion CMR strongly correlate with invasive FFR measurements for intermediate-grade stenosis. These preliminary findings pave the way for further studies evaluating non-invasively intermediate coronary stenosis in clinical practice.
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