Quantitative Perfusion

1352143 - Differences in qualitative and fully-automated quantitative assessment of adenosine stress perfusion CMR in a real-world population of patients – potential clinical consequences

Wednesday, January 25, 2023

Location: E-POSTER

Presenting 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

Primary 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

Co-Author(s)

CV

Caitlin E.M Vink, MD

MD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
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
Luuk H.G.A Hopman

PhD Student
Department of Cardiology, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
MH

Mark B. Hofman, PhD

PhD
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands, 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
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
MB

Mitchel Benovoy, PhD

PhD
Area19 Medical Inc, Montreal, Canada, H2V 2X5
Montreal, Quebec, Canada
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

Background: Stress perfusion cardiovascular magnetic resonance (CMR) is generally assessed by visual interpretation of first-pass perfusion images. As an alternative, absolute myocardial blood flow (MBF) assessment with quantitative perfusion CMR (QP CMR) has been proposed. QP CMR has shown a high diagnostic accuracy for detecting CAD, however it has not been introduced into everyday clinical practice and decision making in patients with CAD. This study aims to assess the differences between qualitative and fully automated QP CMR and its potential clinical implications in a real-world population of patients.

Methods: This retrospective study included 73 patients referred for adenosine stress perfusion CMR who were scanned with dual-bolus scanning protocol between 05.2021-08.2022. Qualitative assessments of first-pass perfusion images were made by level 3 CMR expert. Referral to coronary computed tomography angiography (CCTA) and/or invasive coronary angiography (ICA) was on the discretion of referring physician, who was aware of the result of CMR visual assessment. QP analysis was made offline using cvi42 software (Circle Cardiovascular Imaging Inc., Calgary, Canada) equipped with a newly updated, fully automated pixel-wise QP module. Stress MBF in ml/g/min was measured according to the American Heart Association’s 16-segment model. The Youden index was used to identify stress MBF cut-off on a per-vessel basis. Coronary territories with presence of late gadolinium enhancement were excluded from the analysis.

Results:

Final analysis was performed on 59 cases (14 cases were excluded due to technical issues and/or inadequate response to adenosine; age 62±12 years, 54% males, 59% with suspected CAD, 41% with prior history of CAD). Conventional visual CMR assessment diagnosed perfusion defects in 18 patients (30%). Retrospective assessment of automated MBF pixel-wise maps showed discrepancies vs. conventional visual approach in 26/59 cases (44%), including new diagnosis of ischemia (15/26; 58%; visual-/QP+ group, Figures 1,2), larger extent of ischemia (6/26; 23%), smaller extent of ischemia (2/26; 8%) and global MBF reduction (2/26; 8%). ICA was performed in 19 patients and CCTA in 6 patients within 6 months. Among 15 patients from visual-/QP+ group, only 3 underwent ICA, which confirmed obstructive CAD in 66% of cases. Cut-off value of stress MBF for detection of obstructive CAD was ≤1,68 ml/g/min. In total population, conventional visual assessment diagnosed 80 segments having perfusion defect, while in QP stress MBF≤1,68 ml/g/min was found in 199 segments.

Conclusion:

Incorporating of QP CMR into everyday clinical routine may detect ischemia in patients misdiagnosed by only visual assessment, as well as provide detailed information about the ischemic burden. Therefore, QP CMR may significantly alter the diagnostic and therapeutic pathway in real-world patients referred for stress perfusion CMR.