Related Experiment Video
Updated: Jul 9, 2025
Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling
Published on: May 30, 2011
Comparison of Stress-Rest and Stress-LGE Analysis Strategy in Patients Undergoing Stress Perfusion Cardiovascular
Peter P Swoboda1, Gareth D K Matthews2, Pankaj Garg2
1Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.P.S., S.P., J.P.G.).
Insights
Quantifying ischemia burden using stress perfusion cardiovascular magnetic resonance (CMR) is possible without rest perfusion. A novel stress-late gadolinium enhancement (LGE) analysis offers superior diagnostic accuracy for inducible ischemia compared to traditional stress-rest methods.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Cardiac MRI
Background:
- Stress perfusion cardiovascular magnetic resonance (CMR) is a key tool for quantifying myocardial ischemia burden.
- The optimal analytical approach for stress perfusion CMR, particularly without rest perfusion, remains uncertain.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a stress-late gadolinium enhancement (LGE) analysis method for identifying inducible ischemia.
- To compare the diagnostic performance of the stress-LGE method against quantitative coronary angiography and the conventional stress-rest perfusion analysis.
Main Methods:
- Analysis of 666 patients from the CE-MARC study with complete stress/rest perfusion, LGE, and quantitative coronary angiography data.
- Visual grading of perfusion in a 16-segment model, with infarct transmurality assessed by LGE.
- Defining ischemia as a stress perfusion defect without infarction, and evaluating different infarct transmurality thresholds.
Main Results:
- The optimal stress-LGE analysis (stress defect without >75% infarct transmurality) achieved an AUC of 0.843, outperforming the stress-rest method (AUC 0.834).
- The stress-LGE method demonstrated superior diagnostic accuracy (P=0.02) and similar predictive value for major adverse cardiovascular events (HR 2.65).
- Absence of ischemia by either method indicated a favorable long-term prognosis.
Conclusions:
- The optimal definition of inducible ischemia is a stress-induced perfusion defect without transmural infarction.
- The stress-LGE analysis improves diagnostic accuracy compared to the traditional stress-rest method for cardiovascular magnetic resonance.
- A negative finding for ischemia using either analysis strategy predicts a favorable long-term prognosis.
Background:
Stress perfusion cardiovascular magnetic resonance can be performed without rest perfusion for the quantification of ischemia burden. However, the optimal method of analysis is uncertain.
Methods:
We identified 666 patients from CE-MARC (Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease) with complete stress perfusion, rest perfusion, late gadolinium enhancement (LGE), and quantitative coronary angiography data. For each segment of the 16-segment model, perfusion was visually graded during stress and rest imaging, with infarct transmurality assessed from LGE imaging. In the stress-LGE analysis, a segment was defined as ischemic if it had a subendocardial perfusion defect with no infarction. Rest perfusion was not used in this analysis. We compared the diagnostic accuracy of stress-LGE analysis against quantitative coronary angiography and the stress-rest method validated in the original CE-MARC analysis. The diagnostic accuracy of the stress-LGE method was evaluated with different thresholds of infarct transmurality used to define whether an infarcted segment had peri-infarct ischemia.
Results:
The optimal stress-LGE analysis classified all segments with a stress perfusion defect as ischemic unless they had >75% infarct transmurality (area under the curve, 0.843; sensitivity, 75.6%; specificity, 93.1%; P<0.001). This analysis method has superior diagnostic accuracy to the stress-rest method (area under the curve, 0.834; sensitivity, 73.6%; specificity, 93.1%; P<0.001, P value for difference=0.02). Patients were followed-up for median 6.5 years for major adverse cardiovascular events, with the presence of inducible ischemia by either the stress-LGE or stress-rest analysis being similar and strongly predictive (hazard ratio, 2.65; P<0.001, for both).
Conclusions:
In this analysis of CE-MARC, the optimum definition of inducible ischemia was the presence of a stress-induced perfusion defect without transmural infarction. This definition improved the diagnostic accuracy compared with the stress-rest analysis validated in the original study. The absence of ischemia by either analysis strategy conferred a favorable long-term prognosis.
More Related Videos
11:13Quantification of Mouse Heart Left Ventricular Function, Myocardial Strain, and Hemodynamic Forces by Cardiovascular Magnetic Resonance Imaging
Published on: May 24, 2021
05:56Author Spotlight: Enhancing Diagnostic Strategies and Biomarker Development for Comprehensive Lung Function Analysis
Published on: August 9, 2024
