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      Accuracy of dynamic three-dimensional magnetic resonance perfusion imaging for the detection of coronary artery disease in patients with reduced ejection fraction

      1 , 4 , 2 , 3 , 4 , 4 , 7 , 6 , 1 , 5 , 5 , 1 , 1 , 2 , 5 , 8 , 2 , 3 , 1 , 1 , 2 , 3 , * ,
      Imaging
      Akadémiai Kiadó
      Cardiac magnetic resonance perfusion imaging, Coronary artery disease, Heart failure, Late gadolinium enhancement, AUC, area under the curve, CAD, coronary artery disease, CI, confidence interval, CMR, cardiovascular magnetic resonance, CVD, cardiovascular disease, EF, ejection fraction, FFR, fractional flow reserve, HF, heart failure, LGE, late gadolinium enhancement, LV, left ventricular, LVEDD, left ventricular end-diastolic diameter, LVEDV, left ventricular end-diastolic volume, LVEF, left ventricular ejection fraction, LVESV, left ventricular end-systolic volume, MIB, myocardial ischemic burden, QCA, quantitative coronary angiography, ROC, receiver operator characteristics, SD, standard deviation, SPECT, single-photon emission computed tomography

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          Abstract

          Background

          To assess the accuracy of 3D cardiovascular magnetic resonance (CMR) perfusion imaging for the detection of coronary artery disease (CAD) against fractional flow reserve (FFR) and quantitative coronary angiography (QCA) in patients with reduced ejection fraction (EF).

          Methods

          Out of 447 patients who underwent 3D CMR perfusion imaging (at 1.5 and 3.0 T under adenosine stress and at rest) at 5 European centers, 86 cases with an EF ≤50% were identified (mean age 64 ± 11 yrs, 80% male). Significant CAD was defined as a FFR value <0.8 and a QCA >50%. 86 individuals matched for age, gender and major cardiovascular risk factors, were chosen as the control group.

          Results

          The prevalence of CAD defined by FFR (<0.8) was 59% (EF≤50%) vs. 54% (EF>50%), P = 0.4). In relation to FFR, 3D perfusion imaging yielded a sensitivity of 84.5% (95% CI 76.0–90.4) and specificity of 77.3% (95% CI 66.7–85.3). The sensitivity of perfusion imaging was higher in patients with an EF≤50% (90.2 vs. 78.3%, P = 0.1) whereas specificity showed the reverse (62.9 vs. 90.0%, P = 0.005) The diagnostic accuracy was comparable in both subgroups (AUC 79.1 vs. 83.7%, P = 0.25). According to QCA, the prevalence of CAD was 78 vs. 72% ( P = 0.4). Perfusion imaging yielded a sensitivity and specificity of 82.1 vs. 62.9%, P = 0.01 and 79.0 vs. 95.8%, P = 0.09 respectively with a high diagnostic accuracy in both subgroups (AUC 82.0 vs. 80.5%).

          Conclusion

          3D-CMR perfusion imaging yields a high sensitivity and diagnostic accuracy with regards to the detection of significant CAD irrespective of left ventricular (LV) systolic function.

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          Author and article information

          Contributors
          Journal
          1647
          Imaging
          Imaging
          Akadémiai Kiadó (Budapest )
          2732-0960
          19 June 2021
          09 September 2020
          : 13
          : 1
          : 61-68
          Affiliations
          [1 ] Institute of Diagnostic and Interventional Radiology, University Hospital Zurich , Zurich, Switzerland
          [2 ] Department of Cardiology, University Heart Centre, University Hospital Zurich , Zurich, Switzerland
          [3 ] Institute for Biomedical Engineering, University and ETH Zurich , Zurich, Switzerland
          [4 ] Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig , Leipzig, Germany
          [5 ] Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen , Aachen, Germany
          [6 ] German Heart Institute , Berlin, Germany
          [7 ] Multidisciplinary Cardiovascular Research Centre & the Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, UK
          [8 ] Cardiology, Royal Brompton and Harefield Hospitals and Imperial College , London, UK
          Author notes
          [* ]Corresponding author. Department of Cardiology, University Heart Centre Zurich, University Hospital Zurich , Rämistrasse 100, 8091, Zurich, Switzerland. Tel.: +41 44 255 12 51; fax: +41 44 255 44 01. E-mail: robert.manka@ 123456usz.ch
          Article
          10.1556/1647.2020.00007
          d46b3c26-f74f-480d-8762-d47c9cbc0d52
          © 2020 The Author(s)

          Open Access. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

          Page count
          Figures: 1, Tables: 2, Equations: 0, References: 12, Pages: 08
          Funding
          Funded by: Swiss National Science Foundation
          Award ID: CR3213_132671/1
          Funded by: Bayer Healthcare
          Funded by: Philips Healthcare and the Swiss Heart Foundation

          Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
          Cardiac magnetic resonance perfusion imaging,Coronary artery disease,Heart failure,Late gadolinium enhancement,area under the curve,CAD,coronary artery disease,CI,confidence interval,CMR,cardiovascular magnetic resonance,CVD,cardiovascular disease,EF,ejection fraction,FFR,fractional flow reserve,MIB,myocardial ischemic burden,QCA,quantitative coronary angiography,ROC,receiver operator characteristics,SD,standard deviation,SPECT,single-photon emission computed tomography,AUC,left ventricular end-diastolic volume,LVEF,left ventricular ejection fraction,LVESV,left ventricular end-systolic volume,LVEDV,left ventricular end-diastolic diameter,LVEDD,left ventricular,LV,late gadolinium enhancement,LGE,heart failure,HF

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