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European Heart Journal Advance Access published online on May 23, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl039
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received July 25, 2005
Revised April 6, 2006
Accepted May 4, 2006

Clinical research

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

Johannes Rieber 1 *, Armin Huber 2, Isabelle Erhard 1, Silvia Mueller 1, Michael Schweyer 2, Andreas Koenig 1, Thomas M. Schiele 1, Karl Theisen 1, Uwe Siebert 3, Stefan O. Schoenberg 2, Maximilian Reiser 2, and Volker Klauss 1

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

* To whom correspondence should be addressed.
Johannes Rieber, E-mail: johannes.rieber{at}med.uni-muenchen.de


  Abstract

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.

Keywords: CMRI; Coronary artery disease; Fractional flow reserve.
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