Henk Everaars1, Nina W van der Hoeven1, Gladys N Janssens1, Maarten A van Leeuwen2, Ramon B van Loon1, Stefan P Schumacher1, Ahmet Demirkiran1, Mark B M Hofman3, Rob J van der Geest4, Peter M van de Ven5, Marco J Götte1, Albert C van Rossum1, Niels van Royen6, Robin Nijveldt7. 1. Department of Cardiology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands. 2. Department of Cardiology, Isala Clinics, Zwolle, the Netherlands. 3. Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands. 4. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 5. Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Amsterdam, the Netherlands. 6. Department of Cardiology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Centers, Nijmegen, the Netherlands. 7. Department of Cardiology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Centers, Nijmegen, the Netherlands. Electronic address: robin@nijveldt.net.
Abstract
OBJECTIVES: This study sought to determine the agreement between cardiac magnetic resonance (CMR) imaging and invasive measurements of fractional flow reserve (FFR) in the evaluation of nonculprit lesions after ST-segment elevation myocardial infarction (STEMI). In addition, we investigated whether fully quantitative analysis of myocardial perfusion is superior to semiquantitative and visual analysis. BACKGROUND: The agreement between CMR and FFR in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease is unknown. METHODS: Seventy-seven patients with STEMI with at least 1 intermediate (diameter stenosis 50% to 90%) nonculprit lesion underwent CMR and invasive coronary angiography in conjunction with FFR measurements at 1 month after primary intervention. The imaging protocol included stress and rest perfusion, cine imaging, and late gadolinium enhancement. Fully quantitative, semiquantitative, and visual analysis of myocardial perfusion were compared against a reference of FFR. Hemodynamically obstructive was defined as FFR ≤0.80. RESULTS: Hemodynamically obstructive nonculprit lesions were present in 31 (40%) patients. Visual analysis displayed an area under the curve (AUC) of 0.74 (95% confidence interval [CI]: 0.62 to 0.83), with a sensitivity of 73% and a specificity of 70%. For semiquantitative analysis, the relative upslope of the stress signal intensity time curve and the relative upslope derived myocardial flow reserve had respective AUCs of 0.66 (95% CI: 0.54 to 0.77) and 0.71 (95% CI: 0.59 to 0.81). Fully quantitative analysis did not augment diagnostic performance (all p > 0.05). Stress myocardial blood flow displayed an AUC of 0.76 (95% CI: 0.64 to 0.85), with a sensitivity of 69% and a specificity of 77%. Similarly, MFR displayed an AUC of 0.82 (95% CI: 0.71 to 0.90), with a sensitivity of 82% and a specificity of 71%. CONCLUSIONS: CMR and FFR have moderate-good agreement in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease. Fully quantitative, semiquantitative, and visual analysis yield similar diagnostic performance.
OBJECTIVES: This study sought to determine the agreement between cardiac magnetic resonance (CMR) imaging and invasive measurements of fractional flow reserve (FFR) in the evaluation of nonculprit lesions after ST-segment elevation myocardial infarction (STEMI). In addition, we investigated whether fully quantitative analysis of myocardial perfusion is superior to semiquantitative and visual analysis. BACKGROUND: The agreement between CMR and FFR in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease is unknown. METHODS: Seventy-seven patients with STEMI with at least 1 intermediate (diameter stenosis 50% to 90%) nonculprit lesion underwent CMR and invasive coronary angiography in conjunction with FFR measurements at 1 month after primary intervention. The imaging protocol included stress and rest perfusion, cine imaging, and late gadolinium enhancement. Fully quantitative, semiquantitative, and visual analysis of myocardial perfusion were compared against a reference of FFR. Hemodynamically obstructive was defined as FFR ≤0.80. RESULTS: Hemodynamically obstructive nonculprit lesions were present in 31 (40%) patients. Visual analysis displayed an area under the curve (AUC) of 0.74 (95% confidence interval [CI]: 0.62 to 0.83), with a sensitivity of 73% and a specificity of 70%. For semiquantitative analysis, the relative upslope of the stress signal intensity time curve and the relative upslope derived myocardial flow reserve had respective AUCs of 0.66 (95% CI: 0.54 to 0.77) and 0.71 (95% CI: 0.59 to 0.81). Fully quantitative analysis did not augment diagnostic performance (all p > 0.05). Stress myocardial blood flow displayed an AUC of 0.76 (95% CI: 0.64 to 0.85), with a sensitivity of 69% and a specificity of 77%. Similarly, MFR displayed an AUC of 0.82 (95% CI: 0.71 to 0.90), with a sensitivity of 82% and a specificity of 71%. CONCLUSIONS: CMR and FFR have moderate-good agreement in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease. Fully quantitative, semiquantitative, and visual analysis yield similar diagnostic performance.
Authors: Mohamad B Taha; Eric I Jeng; Michael Salerno; Diego Moguillansky; Ellen C Keeley; Mohammad A Al-Ani Journal: Front Cardiovasc Med Date: 2022-02-24