Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
Eur Radiol. 2023 Jan;33(1):339-347. doi: 10.1007/s00330-022-09040-7. Epub 2022 Aug 19.
In patients of advanced age, the feasibility of myocardial ischemia testing might be limited by age-related comorbidities and falling compliance abilities. Therefore, we aimed to test the accuracy of 3D cardiac magnetic resonance (CMR) stress perfusion in the elderly population as compared to reference standard fractional flow reserve (FFR).
Fifty-six patients at age 75 years or older (mean age 79 ± 4 years, 35 male) underwent 3D CMR perfusion imaging and invasive coronary angiography with FFR in 5 centers using the same study protocol. The diagnostic accuracy of CMR was compared to a control group of 360 patients aged below 75 years (mean age 61 ± 9 years, 262 male). The percentage of myocardial ischemic burden (MIB) relative to myocardial scar burden was further analyzed using semi-automated software.
Sensitivity, specificity, and positive and negative predictive values of 3D perfusion CMR deemed similar for both age groups in the detection of hemodynamically relevant (FFR < 0.8) stenosis (≥ 75 years: 86%, 83%, 92%, and 75%; < 75 years: 87%, 80%, 82%, and 85%; p > 0.05 all). While MIB was larger in the elderly patients (15% ± 17% vs. 9% ± 13%), the diagnostic accuracy of 3D CMR perfusion was high in both elderly and non-elderly populations to predict pathological FFR (AUC: 0.906 and 0.866).
3D CMR perfusion has excellent diagnostic accuracy for the detection of hemodynamically relevant coronary stenosis, independent of patient age.
• The increasing prevalence of coronary artery disease in elderly populations is accompanied with a larger ischemic burden of the myocardium as compared to younger individuals. • 3D cardiac magnetic resonance perfusion imaging predicts pathological fractional flow reserve in elderly patients aged ≥ 75 years with high diagnostic accuracy. • Ischemia testing with 3D CMR perfusion imaging has similarly high accuracy in the elderly as in younger patients and it might be particularly useful when other non-invasive techniques are limited by aging-related comorbidities and falling compliance abilities.
在高龄患者中，由于与年龄相关的合并症和顺应性下降，心肌缺血检测的可行性可能受到限制。因此，我们旨在测试与参考标准血流储备分数（FFR）相比，3D 心脏磁共振（CMR）应激灌注在老年人群中的准确性。
56 名年龄在 75 岁或以上（平均年龄 79 ± 4 岁，35 名男性）的患者在 5 个中心接受了 3D CMR 灌注成像和有创冠状动脉造影，并使用相同的研究方案进行了 FFR。将 CMR 的诊断准确性与 360 名年龄在 75 岁以下的对照组患者（平均年龄 61 ± 9 岁，262 名男性）进行比较。使用半自动软件进一步分析心肌缺血负担（MIB）与心肌瘢痕负担的百分比。
在检测血流动力学相关（FFR < 0.8）狭窄（≥ 75 岁：86%、83%、92%和 75%；< 75 岁：87%、80%、82%和 85%；p > 0.05）时，3D 灌注 CMR 对两个年龄组的敏感性、特异性、阳性和阴性预测值均相似。虽然老年患者的 MIB 较大（15% ± 17%比 9% ± 13%），但 3D CMR 灌注在老年和非老年人群中预测病理性 FFR 的诊断准确性均较高（AUC：0.906 和 0.866）。
3D CMR 灌注对血流动力学相关冠状动脉狭窄的检测具有出色的诊断准确性，与患者年龄无关。
随着老年人群中冠状动脉疾病的患病率增加，与年轻个体相比，心肌的缺血负担更大。
3D 心脏磁共振灌注成像以高诊断准确性预测≥75 岁老年患者的病理性血流储备分数。
3D CMR 灌注成像的缺血检测在老年人和年轻患者中具有相同的高准确性，当其他非侵入性技术因与年龄相关的合并症和顺应性下降而受到限制时，它可能特别有用。
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