Haseeb Rahman1, Cian M Scannell2, Ozan M Demir1, Matthew Ryan1, Hannah McConkey1, Howard Ellis1, Pier Giorgio Masci2, Divaka Perera3, Amedeo Chiribiri2. 1. School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom. 2. School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom. 3. School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom. Electronic address: divaka.perera@kcl.ac.uk.
Abstract
OBJECTIVES: This study assessed the ability to identify coronary microvascular dysfunction (CMD) in patients with angina and nonobstructive coronary artery disease (NOCAD) using high-resolution cardiac magnetic resonance (CMR) and hypothesized that quantitative perfusion techniques would have greater accuracy than visual analysis. BACKGROUND: Half of all patients with angina are found to have NOCAD, while the presence of CMD portends greater morbidity and mortality, it now represents a modifiable therapeutic target. Diagnosis currently requires invasive assessment of coronary blood flow during angiography. With greater reliance on computed tomography coronary angiography as a first-line tool to investigate angina, noninvasive tests for diagnosing CMD warrant validation. METHODS: Consecutive patients with angina and NOCAD were enrolled. Intracoronary pressure and flow measurements were acquired during rest and vasodilator-mediated hyperemia. CMR (3-T) was performed and analyzed by visual and quantitative techniques, including calculation of myocardial blood flow (MBF) during hyperemia (stress MBF), transmural myocardial perfusion reserve (MPR: MBFHYPEREMIA / MBFREST), and subendocardial MPR (MPRENDO). CMD was defined dichotomously as an invasive coronary flow reserve <2.5, with CMR readers blinded to this classification. RESULTS: A total of 75 patients were enrolled (57 ± 10 years of age, 81% women). Among the quantitative perfusion indices, MPRENDO and MPR had the highest accuracy (area under the curve [AUC]: 0.90 and 0.88) with high sensitivity and specificity, respectively, both superior to visual assessment (both p < 0.001). Visual assessment identified CMD with 58% accuracy (41% sensitivity and 83% specificity). Quantitative stress MBF performed similarly to visual analysis (AUC: 0.64 vs. 0.60; p = 0.69). CONCLUSIONS: High-resolution CMR has good accuracy at detecting CMD but only when analyzed quantitatively. Although omission of rest imaging and stress-only protocols make for quicker scans, this is at the cost of accuracy compared with integrating rest and stress perfusion. Quantitative perfusion CMR has an increasingly important role in the management of patients frequently encountered with angina and NOCAD.
OBJECTIVES: This study assessed the ability to identify coronary microvascular dysfunction (CMD) in patients with angina and nonobstructive coronary artery disease (NOCAD) using high-resolution cardiac magnetic resonance (CMR) and hypothesized that quantitative perfusion techniques would have greater accuracy than visual analysis. BACKGROUND: Half of all patients with angina are found to have NOCAD, while the presence of CMD portends greater morbidity and mortality, it now represents a modifiable therapeutic target. Diagnosis currently requires invasive assessment of coronary blood flow during angiography. With greater reliance on computed tomography coronary angiography as a first-line tool to investigate angina, noninvasive tests for diagnosing CMD warrant validation. METHODS: Consecutive patients with angina and NOCAD were enrolled. Intracoronary pressure and flow measurements were acquired during rest and vasodilator-mediated hyperemia. CMR (3-T) was performed and analyzed by visual and quantitative techniques, including calculation of myocardial blood flow (MBF) during hyperemia (stress MBF), transmural myocardial perfusion reserve (MPR: MBFHYPEREMIA / MBFREST), and subendocardial MPR (MPRENDO). CMD was defined dichotomously as an invasive coronary flow reserve <2.5, with CMR readers blinded to this classification. RESULTS: A total of 75 patients were enrolled (57 ± 10 years of age, 81% women). Among the quantitative perfusion indices, MPRENDO and MPR had the highest accuracy (area under the curve [AUC]: 0.90 and 0.88) with high sensitivity and specificity, respectively, both superior to visual assessment (both p < 0.001). Visual assessment identified CMD with 58% accuracy (41% sensitivity and 83% specificity). Quantitative stress MBF performed similarly to visual analysis (AUC: 0.64 vs. 0.60; p = 0.69). CONCLUSIONS: High-resolution CMR has good accuracy at detecting CMD but only when analyzed quantitatively. Although omission of rest imaging and stress-only protocols make for quicker scans, this is at the cost of accuracy compared with integrating rest and stress perfusion. Quantitative perfusion CMR has an increasingly important role in the management of patients frequently encountered with angina and NOCAD.
Authors: Harmony R Reynolds; C Noel Bairey Merz; Colin Berry; Rohit Samuel; Jacqueline Saw; Nathaniel R Smilowitz; Ana Carolina do A H de Souza; Robert Sykes; Viviany R Taqueti; Janet Wei Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Nidaa Mikail; Alexia Rossi; Susan Bengs; Ahmed Haider; Barbara E Stähli; Angela Portmann; Alessio Imperiale; Valerie Treyer; Alexander Meisel; Aju P Pazhenkottil; Michael Messerli; Vera Regitz-Zagrosek; Philipp A Kaufmann; Ronny R Buechel; Cathérine Gebhard Journal: Eur J Nucl Med Mol Imaging Date: 2022-08-17 Impact factor: 10.057
Authors: Andrew V Mochula; Kristina V Kopeva; Alina N Maltseva; Elena V Grakova; Marina Gulya; Andrey V Smorgon; Anna Gusakova; Konstantin V Zavadovsky Journal: Heart Vessels Date: 2022-09-01 Impact factor: 1.814
Authors: Ashley S Manchanda; Alan C Kwan; Mariko Ishimori; Louise E J Thomson; Debiao Li; Daniel S Berman; C Noel Bairey Merz; Caroline Jefferies; Janet Wei Journal: Front Cardiovasc Med Date: 2022-04-15
Authors: Andreas Seraphim; Benjamin Dowsing; Krishnaraj S Rathod; Hunain Shiwani; Kush Patel; Kristopher D Knott; Sameer Zaman; Ieuan Johns; Yousuf Razvi; Rishi Patel; Hui Xue; Daniel A Jones; Marianna Fontana; Graham Cole; Rakesh Uppal; Rhodri Davies; James C Moon; Peter Kellman; Charlotte Manisty Journal: J Am Coll Cardiol Date: 2022-03-29 Impact factor: 27.203
Authors: Andreas Seraphim; Kristopher D Knott; Joao B Augusto; Katia Menacho; Sara Tyebally; Benjamin Dowsing; Sanjeev Bhattacharyya; Leon J Menezes; Daniel A Jones; Rakesh Uppal; James C Moon; Charlotte Manisty Journal: Front Cardiovasc Med Date: 2021-12-23
Authors: Ozan M Demir; Haseeb Rahman; Tim P van de Hoef; Javier Escaned; Jan J Piek; Sven Plein; Divaka Perera Journal: Eur Heart J Date: 2022-01-13 Impact factor: 29.983