Quantitative Perfusion

1351866 - Diagnostic Performance of Quantitative Cardiac Magnetic Resonance Imaging in Patients with Prior Coronary Artery Disease

Thursday, January 26, 2023

1:00 PM – 2:00 PM

Location: Pacific Jewel

Presenting Author(s)

RH

Roel Hoek, MD

MD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands, Netherlands

Primary Author(s)

RH

Roel Hoek, MD

MD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands, Netherlands

Co-Author(s)

SB

Sonia Borodzicz-Jazdzyk, MD, PhD

MD, PhD
1) Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; 2) 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland., Poland
Pv

Pepijn A. van Diemen, MD

MD
Amsterdam University Medical Centers- Location VUmc, Netherlands
YS

Yvemarie B. Somsen, MD

MD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands, Netherlands
Rd

Ruben W. de Winter, MD

MD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands, Netherlands
RJ

Ruurt A. Jukema, MD

MD
Amsterdam University Medical Centers- Location VUmc, Netherlands
PR

Pieter G. Raijmakers, MD, PhD

MD
Amsterdam University Medical Centers- Location VUmc, Netherlands
JK

Juhani Knuuti, MD, PhD

MD
Turku University Hospital, Finland
TM

Teemu Maaniitty, MD, PhD

MD
Turku University Hospital, Finland
RU

Richard S. Underwood, MD, PhD

MD
Royal Brompton Hospital, United Kingdom
Eike Nagel, MD, PhD

MD
University Hospital Frankfurt
Frankfurt, Hessen, Germany
LR

Lourens F. Robbers, MD, PhD

MD
Amsterdam University Medical Centers- Location VUmc
Amsterdam, Noord-Holland, Netherlands
Ahmet Demirkıran, MD, PhD

Cardiologist
Amsterdam University Medical Centers- Location VUmc
Amsterdam, Turkey
Mv

Martin B. von Bartheld, MD, PhD

MD
Amsterdam University Medical Centers- Location VUmc, Netherlands
RD

Roel S. Driessen, MD

MD
Amsterdam University Medical Centers- Location VUmc, Netherlands
ID

Ibrahim Danad, MD, PhD

MD
Amsterdam University Medical Centers- Location VUmc, Netherlands
Marco J. Götte, MD, PhD

MD, PhD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
PK

Paul Knaapen, MD, PhD

Professor, MD, PhD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
Amsterdam, Netherlands

Background: In patients with documented coronary artery disease (CAD) and new symptoms suggestive of obstructive CAD, cardiac magnetic resonance (CMR) imaging can be applied to assess presence of myocardial ischemia. Quantitative perfusion CMR (QP-CMR) has the potential to improve diagnostic accuracy over visual assessment (v-CMR). The present study assessed the diagnostic accuracy of QP-CMR for detecting haemodynamically significant CAD as compared to v-CMR and positron emission tomography (PET) in this specific patient population.

Methods: This PACIFIC-2 substudy included 126 patients with prior MI and/or PCI, and who were suspected for ischemic CAD. All patients underwent dual-sequence, single bolus perfusion CMR and [¹⁵O]H2OPET imaging followed by invasive coronary angiography with fractional flow reserve (FFR) in all coronary arteries. Analysis of QP-CMR was performed using Circle Cardiovascular Imaging 42 software; all other modalities were reviewed by core laboratories. Hemodynamically significant CAD was defined as an FFR ≤0.80. For QP-CMR, an optimal cutoff value for absolute myocardial blood flow during hyperemia (h-MBF) was calculated to detect significant CAD. Analysis was performed on a per-vessel level. Vascular territories with any late gadolinium enhancement were excluded from analysis.

Results: A total of 289 vessels were included. Comparison of h-MBF between QP-CMR and PET showed a correlation of 0.35 (P< 0.001). The optimal cutoff value of h-MBF in QP-CMR was found at ≤1.36 mL/min/g. Sensitivity of QP-CMR, v-CMR and PET were 45% (95% CI 34-56), 48% (37-59), and 64% (53-74), respectively. Specificity of QP-CMR, v-CMR and PET were 75% (69-81), 83% (78-88), and 70% (63-76). For QP-CMR, sensitivity was found to be lower than PET (P=0.001), whereas specificity was comparable between groups. Diagnostic accuracy did not differ between modalities: 66% for QP-CMR (61-72), 72% for v-CMR (67-77), and 68% for PET (62-74).

Conclusion:

In patients with prior MI and/or PCI, quantitative perfusion CMR did not yield a higher diagnostic accuracy compared to qualitative CMR and quantitative PET imaging for the detection of haemodynamically significant CAD. Of note, QP-CMR and PET h-MBF showed a significant but weak correlation.