National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore.
J Cardiovasc Magn Reson. 2021 Mar 4;23(1):17. doi: 10.1186/s12968-021-00705-8.
Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard.
In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study.
In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94-1.00)] in discriminating between FFR-normal and FFR-positive patients.
The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD.
ClinicalTrials.gov, NCT03217227, Registered 11 July 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart.
应激心血管磁共振（CMR）可在一次检查中评估心室功能、心肌灌注和存活能力，以检测冠状动脉疾病（CAD）。我们开发了一种基于扫描仪的运动应激 CMR（ExCMR）方案，使用仰卧位自行车测力计，并旨在与有创血流储备分数（FFR）作为参考金标准相比，检查多参数方法在疑似 CAD 患者中的诊断价值。
在这项单中心前瞻性研究中，有胸痛症状且至少有一个心血管疾病危险因素的患者接受了 ExCMR 和有创血管造影术，同时进行 FFR 检查。评估了静息状态下的左心室功能（射血分数、区域性壁运动异常）、组织特征和运动应激衍生的 CMR 参数（灌注缺损、可诱导的区域性壁运动异常和峰值运动心脏指数百分位排名）。
在 60 名入选的中度 CAD 风险患者中，根据 FFR，50%的患者存在血流动力学意义上的 CAD。在所评估的所有 CMR 参数中，延迟钆增强、应激诱导的区域性壁运动异常、灌注缺损和峰值运动心脏指数百分位排名与 FFR 阳性 CAD 独立相关。实际上，与临床风险模型相比，这种多参数方法提供了最高的增量诊断价值（χ² 值从 7.6 增加到 55.9；P < 0.001），并且在区分 FFR 正常和 FFR 阳性患者方面具有出色的性能[曲线下面积的 C 统计量为 0.97（95%CI：0.94-1.00）]。
该研究表明，使用基于扫描仪的多参数 ExCMR 准确诊断 CAD 具有临床潜力。
ClinicalTrials.gov，NCT03217227，2017 年 7 月 11 日注册-回顾性注册，https://clinicaltrials.gov/ct2/show/NCT03217227？id=NCT03217227&draw=2&rank=1&load=cart。
