European Heart Journal Advance Access first published online on December 19, 2008
This version published online on January 5, 2009
European Heart Journal, doi:10.1093/eurheartj/ehn521
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Regional myocardial perfusion reserve determined using myocardial perfusion magnetic resonance imaging showed a direct correlation with coronary flow velocity reserve by Doppler flow wire
1 Department of Cardiology, Mie University Hospital, 2-174 Edobashi, Tsu 514-8507, Japan
2 Department of Diagnostic Radiology, Mie University Hospital, 2-174 Edobashi, Tsu 514-8507, Japan
3 Department of Molecular and Laboratory Medicine, Mie University Hospital, 2-174 Edobashi, Tsu 514-8507, Japan
Received 20 May 2008; revised 7 October 2008; accepted 28 October 2008.
* Corresponding author. Tel: +81 59 231 5015, Fax: +81 59 231 5201, Email: k_siho_yuu{at}hotmail.com
Aims: Quantitative analysis of rest–stress myocardial perfusion magnetic resonance imaging (MRI) can provide assessments of regional myocardial perfusion reserve (MPR). The purpose of this study was to compare regional MPR determined by myocardial perfusion MRI with coronary flow reserve (CFR) by intracoronary Doppler flow wire.
Methods and results: Twenty patients with suspected coronary artery disease (CAD) were studied. Average peak velocity was measured by Doppler flow wire in the resting state and during adenosine triphosphate (ATP) stress in 36 coronary arteries. CFR measurements for each patient were performed in the culprit and one non-culprit non-stenotic artery. First-pass, contrast-enhanced myocardial perfusion MR images were obtained in the resting state and during ATP stress within the week before the Doppler wire procedure. Regional myocardial blood flow (MBF) was quantified in 16 myocardial segments by analysing arterial input and myocardial output using a Patlak plot method. MPR was calculated as stress MBF divided by rest MBF. CFR measured by Doppler flow wire was compared with MPR in the myocardial segments corresponding to vessel territories. The average MPR measured by perfusion MRI was 1.77 ± 0.62 for the culprit arteries and 3.45 ± 0.78 for the non-culprit arteries, respectively (P < 0.001). The averaged CFR by Doppler flow wire was 1.72 ± 0.44 in the culprit arteries and 3.14 ± 0.74 in the non-culprit arteries, respectively (P < 0.001). For both culprit and non-culprit vessel groups, significant direct correlations were observed between MR assessments of MPR and Doppler assessments of CFR (culprit artery: R = 0.87, Non-culprit artery: R = 0.86) On Bland–Altman analysis, the mean differences between MPR determined by myocardial perfusion MRI and CFR measured by Doppler wire were 0.05 in culprit arteries (95% limit of agreement; –0.65 to 0.56) and 0.36 in non-culprit arteries (95% limit of agreement; –1.24 to 0.44). The sensitivity and specificity of MR measurement of MPR for predicting physiologically significant reduction of Doppler CFR (<2) was 88% (95% CI 61.7–98.5) and 90% (95% CI 68.3–98.8), respectively.
Conclusion: The current results using Doppler flow wire as a reference method demonstrated that quantitative analysis of stress–rest myocardial perfusion MRI can provide a non-invasive assessment of reduced MPR in patients with CAD.
Key Words: Cardiac magnetic resonance • myocardial blood flow • myocardial perfusion reserve • Doppler flow wire • coronary flow reserve
The originally published version of this paper was incorrect. A revised version of Figure 2 has now been published.