Pereira Eulália, Bettencourt Nuno, Ferreira Nuno, Schuster Andreas, Chiribiri Amedeo, Primo João, Teixeira Madalena, Simões Lino, Leite-Moreira Adelino, Silva-Cardoso José, Gama Vasco, Nagel Eike
Cardiology Department, Centro Hospitalar de Gaia/Espinho, Portugal.
Int J Cardiol. 2013 Oct 9;168(4):4160-7. doi: 10.1016/j.ijcard.2013.07.114. Epub 2013 Aug 12.
Cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) is considered a state-of-the-art non-invasive modality for ischemia detection but its additive value in a multiple-test strategy in patients with suspected coronary artery disease (CAD) is not fully validated. We aimed to evaluate CMR-MPI integration with exercise treadmill test (ETT) for the diagnostic workup of patients with suspected CAD, having invasive fractional flow reserve (FFR) as reference standard.
In this prospective single-center study, patients with suspected CAD underwent sequential ETT, CMR-MPI and X-ray invasive coronary angiography (XA). Significant CAD was defined by the presence of stenosis >40% with FFR ≤ 0.8 in vessels >2 mm or ≥90% stenosis/occlusion.
80 symptomatic patients (68% male, 61 ± 8 years) were enrolled. Compared to ETT, CMR-MPI showed similar sensitivity (81%) and higher specificity (93 vs. 58%, p < 0.001) for CAD detection (prevalence = 46%) translating into better diagnostic performance (AUC 0.87 vs. 0.70; p = 0.002). CMR-MPI improved accuracy independently of ETT in all patients with high pre-test probability and in intermediate-probability patients but those with a clearly positive-ETT (symptoms + ST-shift), in whom ETT correctly identified CAD. In the low-probability group CMR-MPI was useful as a gatekeeper for XA after a positive-ETT. The best integrating protocol achieved a global accuracy of 89% (AUC 0.88) and was clearly superior to an approach based solely in ETT (AUC 0.70, p < 0.001), yet similar to isolated CMR-MPI (AUC 0.87, p = ns).
CMR-MPI has high sensitivity and specificity for CAD detection and may be combined with ETT in a diagnostic workflow aiming to increase accuracy and reduce the number of unnecessary catheterizations.
心脏磁共振心肌灌注成像（CMR-MPI）被认为是用于检测心肌缺血的一种先进的非侵入性方法，但其在疑似冠状动脉疾病（CAD）患者的多项检查策略中的附加价值尚未得到充分验证。我们旨在评估CMR-MPI与运动平板试验（ETT）相结合，以有创血流储备分数（FFR）作为参考标准，对疑似CAD患者进行诊断检查的效果。
在这项前瞻性单中心研究中，疑似CAD患者依次接受ETT、CMR-MPI和X线有创冠状动脉造影（XA）检查。显著CAD定义为直径>2mm的血管中存在狭窄>40%且FFR≤0.8，或狭窄/闭塞≥90%。
共纳入80例有症状患者（68%为男性，年龄61±8岁）。与ETT相比，CMR-MPI对CAD检测的敏感性相似（81%），特异性更高（分别为93%和58%，p<0.001）（患病率=46%），这意味着其诊断性能更好（AUC分别为0.87和0.70；p=0.002）。在所有预测试概率高的患者和中概率患者中，CMR-MPI独立于ETT提高了准确性，但对于ETT结果明显为阳性（症状+ST段移位）的患者，ETT能够正确识别CAD。在低概率组中，ETT结果为阳性后，CMR-MPI可作为XA的筛选检查。最佳整合方案的总体准确率达到89%（AUC 0.88），明显优于仅基于ETT的方法（AUC 0.70，p<0.001），但与单独的CMR-MPI相似（AUC 0.87，p=无显著差异）。
CMR-MPI对CAD检测具有高敏感性和特异性，可与ETT结合用于诊断流程，以提高准确性并减少不必要的导管插入术数量。
