Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 148149 Münster, Germany.
Division of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110 70376 Stuttgart, Germany.
Eur Heart J Cardiovasc Imaging. 2017 May 1;18(8):851-859. doi: 10.1093/ehjci/jew315.
Myocardial perfusion reserve (MPR) is defined as the maximal possible increase in myocardial blood flow (MBF) above baseline conditions. Global MBF can be measured non-invasively by means of coronary sinus flow velocity encoded cine (VENC) cardiovascular magnetic resonance (CMR). We aimed to explore the relationship between global MBF/MPR and the extent and severity of coronary artery disease (CAD) in patients referred for CAD work-up by adenosine-stress CMR.
Fifty-eight patients with suspected obstructive CAD underwent both adenosine-stress CMR and invasive coronary angiography. In addition to standard cine- and late gadolinium enhancement (LGE)-imaging, first-pass myocardial perfusion imaging (MPI) and coronary sinus flow measurements (VENC) were performed at rest and during peak stress (after 140 µg/kg/min adenosine), respectively. Nineteen young patients with a very low CAD pre-test probability and normal adenosine-stress CMR formed the control group. Fifty-nine percent (n = 34) of the study group showed segmental, adenosine-induced myocardial perfusion defects compared to none of the control group (P < 0.001). Global MPR was lower in the study group compared to the control group: 2.3 (1.5-3.1) vs. 3.1 (2.0-4.3), P = 0.016. The SYNTAX score was higher in the study group patients with an impaired MPR (<2) compared to those with a preserved MPR (3.0 vs. 16.0, P = 0.01)-mainly due to higher prevalence of proximal epicardial stenoses (60% vs. 27%, P = 0.02) and multi-vessel disease (56% vs. 24%, P = 0.017). The diagnostic yield of stress CMR for the diagnosis of CAD (>50% stenosis) increased from 65to 88% when global MPR assessment was considered in addition to MPI (P = 0.025).
Global MBF and MPR values correlate with the anatomical extent and complexity of CAD and increase the diagnostic yield of non-invasive stress CMR in the work-up of CAD. CMR-based MBF and MPR measurements may play a future role in the evaluation of the total ischaemic burden-particularly in patients with multi-vessel disease.
心肌灌注储备（MPR）定义为基础状态下心肌血流（MBF）最大可能的增加。通过冠状窦血流速度编码电影（VENC）心血管磁共振（CMR）可以非侵入性地测量整体 MBF。我们旨在探讨腺苷应激 CMR 检查疑似 CAD 患者的整体 MBF/MPR 与冠状动脉疾病（CAD）的程度和严重程度之间的关系。
58 例疑似阻塞性 CAD 的患者接受了腺苷应激 CMR 和有创性冠状动脉造影检查。除了标准的电影和晚期钆增强（LGE）成像外，还分别在静息和峰值应激时（在 140μg/kg/min 腺苷后）进行首过心肌灌注成像（MPI）和冠状窦血流测量（VENC）。19 名 CAD 术前概率极低且腺苷应激 CMR 正常的年轻患者作为对照组。研究组中有 59%（n=34）的患者出现节段性、腺苷诱导的心肌灌注缺陷，而对照组无一人出现（P<0.001）。与对照组相比，研究组的整体 MPR 较低：2.3（1.5-3.1）比 3.1（2.0-4.3），P=0.016。在 MPR 受损（<2）的研究组患者中，SYNTAX 评分高于 MPR 正常的患者（3.0 比 16.0，P=0.01），主要是由于心外膜近端狭窄（60%比 27%，P=0.02）和多血管疾病（56%比 24%，P=0.017）的患病率较高。当在 MPI 之外考虑整体 MPR 评估时，应激 CMR 对 CAD（>50%狭窄）的诊断率从 65%增加到 88%（P=0.025）。
整体 MBF 和 MPR 值与 CAD 的解剖范围和复杂性相关，并增加了非侵入性应激 CMR 在 CAD 检查中的诊断率。基于 CMR 的 MBF 和 MPR 测量可能在评估总缺血负担方面发挥未来作用，特别是在多血管疾病患者中。
