Chiribiri Amedeo, Villa Adriana D M, Sammut Eva, Breeuwer Marcel, Nagel Eike
Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK.
Eur Heart J Cardiovasc Imaging. 2016 Dec;17(12):1414-1423. doi: 10.1093/ehjci/jev326. Epub 2015 Dec 24.
We sought to describe perfusion dyssynchrony analysis specifically to exploit the high temporal resolution of stress perfusion CMR. This novel approach detects differences in the temporal distribution of the wash-in of contrast agent across the left ventricular wall.
Ninety-eight patients with suspected coronary artery disease (CAD) were retrospectively identified. All patients had undergone perfusion CMR at 3T and invasive angiography with fractional flow reserve (FFR) of lesions visually judged >50% stenosis. Stress images were analysed using four different perfusion dyssynchrony indices: the variance and coefficient of variation of the time to maximum signal upslope (V-TTMU and C-TTMU) and the variance and coefficient of variation of the time to peak myocardial signal enhancement (V-TTP and C-TTP). Patients were classified according to the number of vessels with haemodynamically significant CAD indicated by FFR <0.8. All indices of perfusion dyssynchrony were capable of identifying the presence of significant CAD. C-TTP >10% identified CAD with sensitivity 0.889, specificity 0.857 (P < 0.0001). All indices correlated with the number of diseased vessels. C-TTP >12% identified multi-vessel disease with sensitivity 0.806, specificity 0.657 (P < 0.0001). C-TTP was also the dyssynchrony index with the best inter- and intra-observer reproducibility. Perfusion dyssynchrony indices showed weak correlation with other invasive and non-invasive measurements of the severity of ischaemia, including FFR, visual ischaemic burden, and MPR.
These findings suggest that perfusion dyssynchrony analysis is a robust novel approach to the analysis of first-pass perfusion and has the potential to add complementary information to aid assessment of CAD.
我们试图描述灌注不同步分析，特别是利用负荷灌注心脏磁共振成像（CMR）的高时间分辨率。这种新方法可检测造影剂在左心室壁内流入的时间分布差异。
回顾性纳入98例疑似冠心病（CAD）患者。所有患者均在3T条件下接受了灌注CMR检查，并进行了有创血管造影，目测病变的血流储备分数（FFR）>50%狭窄。使用四种不同的灌注不同步指数分析负荷图像：最大信号上升斜率时间的方差和变异系数（V-TTMU和C-TTMU）以及心肌信号增强峰值时间的方差和变异系数（V-TTP和C-TTP）。根据FFR<0.8所示的具有血流动力学意义的CAD血管数量对患者进行分类。所有灌注不同步指数均能够识别显著CAD的存在。C-TTP>10%识别CAD的敏感性为0.889，特异性为0.857（P<0.0001）。所有指数均与病变血管数量相关。C-TTP>12%识别多支血管病变的敏感性为0.806，特异性为0.657（P<0.0001）。C-TTP也是观察者间和观察者内重复性最好的不同步指数。灌注不同步指数与其他有创和无创缺血严重程度测量指标（包括FFR、目测缺血负荷和心肌灌注储备）的相关性较弱。
这些发现表明，灌注不同步分析是一种可靠的首次通过灌注分析新方法，有可能提供补充信息以辅助CAD的评估。
