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European Heart Journal Advance Access originally published online on May 23, 2006
European Heart Journal 2006 27(12):1465-1471; doi:10.1093/eurheartj/ehl039
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Cardiac magnetic resonance perfusion imaging for the functional assessment of coronary artery disease: a comparison with coronary angiography and fractional flow reserve

Johannes Rieber1,*,{dagger}, Armin Huber2,{dagger}, Isabelle Erhard1, Silvia Mueller1, Michael Schweyer2, Andreas Koenig1, Thomas M. Schiele1, Karl Theisen1, Uwe Siebert3, Stefan O. Schoenberg2, Maximilian Reiser2 and Volker Klauss1

1 Department of Cardiology, Division of Internal Medicine, University of Munich Germany
2 Institute for Clinical Radiology, University of Munich, Germany
3 Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Received 25 July 2005; revised 6 April 2006; accepted 4 May 2006; online publish-ahead-of-print 23 May 2006.

* Corresponding author: Medizinische Poliklinik der Universität München—Innenstadt Ziemssenstr. 1 80336 München, Germany. Tel: +49 89 5160 2177; fax: +49 89 5160 2152. E-mail address: johannes.rieber{at}med.uni-muenchen.de

Aims Cardiac magnetic resonance perfusion imaging (CMRI) is a promising technique for non-invasive measurement of myocardial perfusion reserve. Fractional flow reserve (FFR) is an established invasive method for functional assessment of coronary artery disease (CAD). To prospectively assess the diagnostic value of CMRI for the detection of haemodynamically significant coronary lesions, compared with coronary angiography (CA) and FFR.

Methods and results Forty-three patients with suspected or known CAD underwent CA, CMRI, and FFR measurement. First pass magnetic resonance perfusion examination was performed during hyperaemia (140 µg/kg/min adenosine over 6 min) and at rest. One hundred and twenty-nine perfusion territories were assessed by semi-quantitative evaluation of signal intensity–time curves using the myocardial perfusion reserve index (MPRI) [upslopestress(corrected)/upsloperest(corrected)]. Perfusion territories were categorized as normal (coronary stenosis≤50%), intermediate (stenosis>50% and FFR>0.75), or severe (stenosis>50% and FFR≤0.75 or total occlusion). MPRI values (±SD) were significantly different between the three categories [normal, 2.2±0.5 vs. intermediate, 1.8±0.5 (P=0.005) and intermediate vs. severe, 1.2±0.3 (P<0.001)]. An MPRI cut-off value of 1.5 (derived from receiver operating characteristics analysis) distinguished haemodynamically relevant (severe) from non-relevant (normal and intermediate) stenoses with a sensitivity of 88% (CI 74–100%) and a specificity of 90% (CI 84–96%).

Conclusion In contrast to earlier studies that compared CMRI with morphological examination (CA) alone, the present study compared CMRI with CA plus a standard invasive functional assessment (FFR) and demonstrated that CMRI is able to distinguish haemodynamically relevant from non-relevant coronary lesions with a high sensitivity and specificity and may therefore contribute to clinical decision-making.

Key Words: CMRI • Coronary artery disease • Fractional flow reserve


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