Olivier Ghekiere1,2,3, Jean-Nicolas Dacher4, Willem Dewilde5, Isabelle Mancini1, Wilfried Cools6, Piet K Vanhoenacker7, Paul Dendale3,8, Patrizio Lancellotti9,10, Albert de Roos11, Alain Nchimi9,12. 1. 1 Department of Radiology, Centre Hospitalier Chrétien, Liège, Belgium. 2. 2 Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium. 3. 3 Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. 4. 4 Department of Radiology, University Hospital, Rouen, France. 5. 5 Department of Cardiology, Imelda Hospital, Bonheiden, Belgium. 6. 6 I-BioStat, Centre for Statistics, Hasselt University, Hasselt, Belgium. 7. 7 Department of Radiology, OLV Ziekenhuis, Aalst, Belgium. 8. 8 Heart Center Hasselt, Jessa Ziekenhuis, Hasselt, Belgium. 9. 9 Department of Cardiology, Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium. 10. 10 Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy. 11. 11 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 12. 12 Department of Cardiovascular Imaging, Centre Hospitalier de Luxembourg, 4 Rue Ernest Barblé, L-1210, Luxembourg.
Abstract
OBJECTIVE: Correcting the perfusion in areas distal to coronary stenosis (risk) according to that of normal (remote) areas defines the relative myocardial perfusion index, which is similar to the fractional flow reserve (FFR) concept. The aim of this study was to assess the value of relative myocardial perfusion by MRI in predicting lesion-specific inducible ischemia as defined by FFR. MATERIALS AND METHODS: Forty-six patients (33 men and 13 women; mean [± SD] age, 61 ± 9 years) who underwent adenosine perfusion MRI and FFR measurement distal to 49 coronary artery stenoses during coronary angiography were retrospectively evaluated. Subendocardial time-enhancement maximal upslopes, normalized by the respective left ventricle cavity upslopes, were obtained in risk and remote subendocardium during adenosine and rest MRI perfusion and were correlated to the FFR values. RESULTS: The mean FFR value was 0.84 ± 0.09 (range, 0.60-0.98) and was less than or equal to 0.80 in 31% of stenoses (n = 15). The relative subendocardial perfusion index (risk-to-remote upslopes) during hyperemia showed better correlations with the FFR value (r = 0.59) than the uncorrected risk perfusion parameters (i.e., both the upslope during hyperemia and the perfusion reserve index [stress-to-rest upslopes]; r = 0.27 and 0.29, respectively). A cutoff value of 0.84 of the relative subendocardial perfusion index had an ROC AUC of 0.88 to predict stenosis at an FFR of less than or equal to 0.80. CONCLUSION: Using adenosine perfusion MRI, the relative myocardial perfusion index enabled the best prediction of FFR-defined lesion-specific myocardial ischemia. This index could be used to noninvasively determine the need for revascularization of known coronary stenoses.
OBJECTIVE: Correcting the perfusion in areas distal to coronary stenosis (risk) according to that of normal (remote) areas defines the relative myocardial perfusion index, which is similar to the fractional flow reserve (FFR) concept. The aim of this study was to assess the value of relative myocardial perfusion by MRI in predicting lesion-specific inducible ischemia as defined by FFR. MATERIALS AND METHODS: Forty-six patients (33 men and 13 women; mean [± SD] age, 61 ± 9 years) who underwent adenosine perfusion MRI and FFR measurement distal to 49 coronary artery stenoses during coronary angiography were retrospectively evaluated. Subendocardial time-enhancement maximal upslopes, normalized by the respective left ventricle cavity upslopes, were obtained in risk and remote subendocardium during adenosine and rest MRI perfusion and were correlated to the FFR values. RESULTS: The mean FFR value was 0.84 ± 0.09 (range, 0.60-0.98) and was less than or equal to 0.80 in 31% of stenoses (n = 15). The relative subendocardial perfusion index (risk-to-remote upslopes) during hyperemia showed better correlations with the FFR value (r = 0.59) than the uncorrected risk perfusion parameters (i.e., both the upslope during hyperemia and the perfusion reserve index [stress-to-rest upslopes]; r = 0.27 and 0.29, respectively). A cutoff value of 0.84 of the relative subendocardial perfusion index had an ROC AUC of 0.88 to predict stenosis at an FFR of less than or equal to 0.80. CONCLUSION: Using adenosine perfusion MRI, the relative myocardial perfusion index enabled the best prediction of FFR-defined lesion-specific myocardial ischemia. This index could be used to noninvasively determine the need for revascularization of known coronary stenoses.
Authors: Waqas Ullah; Sohaib Roomi; Hafez M Abdullah; Maryam Mukhtar; Zain Ali; Ping Ye; Donald C Haas; Vincent M Figueredo Journal: Cardiol Res Date: 2020-05-03