疑似冠状动脉狭窄患者的磁共振心肌血流：与 PET 和有创生理学的比较。
Myocardial Blood Flow by Magnetic Resonance in Patients With Suspected Coronary Stenosis: Comparison to PET and Invasive Physiology.
机构信息
Department of Cardiology (L.D.R., A.E., J.N.D., M.B., S.W.), Gødstrup Hospital, Herning, Denmark.
Department of Cardiology, Aalborg University Hospital, Denmark (L.D.R.).
出版信息
Circ Cardiovasc Imaging. 2024 Jun;17(6):e016635. doi: 10.1161/CIRCIMAGING.124.016635. Epub 2024 Jun 18.
BACKGROUND
Despite recent guideline recommendations, quantitative perfusion (QP) estimates of myocardial blood flow from cardiac magnetic resonance (CMR) have only been sparsely validated. Furthermore, the additional diagnostic value of utilizing QP in addition to the traditional visual expert interpretation of stress-perfusion CMR remains unknown. The aim was to investigate the correlation between myocardial blood flow measurements estimated by CMR, positron emission tomography, and invasive coronary thermodilution. The second aim is to investigate the diagnostic performance of CMR-QP to identify obstructive coronary artery disease (CAD).
METHODS
Prospectively enrolled symptomatic patients with >50% diameter stenosis on computed tomography angiography underwent dual-bolus CMR and positron emission tomography with rest and adenosine-stress myocardial blood flow measurements. Subsequently, an invasive coronary angiography (ICA) with fractional flow reserve and thermodilution-based coronary flow reserve was performed. Obstructive CAD was defined as both anatomically severe (>70% diameter stenosis on quantitative coronary angiography) or hemodynamically obstructive (ICA with fractional flow reserve ≤0.80).
RESULTS
About 359 patients completed all investigations. Myocardial blood flow and reserve measurements correlated weakly between estimates from CMR-QP, positron emission tomography, and ICA-coronary flow reserve (r<0.40 for all comparisons). In the diagnosis of anatomically severe CAD, the interpretation of CMR-QP by an expert reader improved the sensitivity in comparison to visual analysis alone (82% versus 88% [=0.03]) without compromising specificity (77% versus 74% [=0.28]). In the diagnosis of hemodynamically obstructive CAD, the accuracy was only moderate for a visual expert read and remained unchanged when additional CMR-QP measurements were interpreted.
CONCLUSIONS
CMR-QP correlates weakly to myocardial blood flow measurements by other modalities but improves diagnosis of anatomically severe CAD.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481712.
背景
尽管最近有指南建议，但心脏磁共振（CMR）的定量灌注（QP）估计心肌血流的方法仅得到了稀疏验证。此外，在利用压力灌注 CMR 的传统视觉专家解读之外，利用 QP 的额外诊断价值仍然未知。目的是研究 CMR、正电子发射断层扫描和侵入性冠状动脉热稀释法测量的心肌血流之间的相关性。目的二是研究 CMR-QP 识别阻塞性冠状动脉疾病（CAD）的诊断性能。
方法
前瞻性招募计算机断层血管造影术上存在 >50%直径狭窄的有症状患者，进行双对比剂 CMR 和正电子发射断层扫描，同时进行静息和腺苷负荷心肌血流测量。随后进行有创冠状动脉造影术（ICA），并进行血流储备分数和基于热稀释的冠状动脉血流储备测量。阻塞性 CAD 的定义为解剖学上严重（定量冠状动脉造影上>70%直径狭窄）或血流动力学上阻塞（ICA 时血流储备分数≤0.80）。
结果
约 359 名患者完成了所有检查。CMR-QP、正电子发射断层扫描和 ICA 冠状动脉血流储备的心肌血流和储备测量之间相关性较弱（所有比较的 r<0.40）。在诊断解剖学上严重 CAD 时，与仅进行视觉分析相比，专家解读 CMR-QP 可提高敏感性（82% 比 88% [=0.03]），而特异性不变（77% 比 74% [=0.28]）。在诊断血流动力学上阻塞性 CAD 时，视觉专家解读的准确性仅为中等，当额外解读 CMR-QP 测量值时，准确性仍未改变。
结论
CMR-QP 与其他模态的心肌血流测量相关性较弱，但可改善解剖学上严重 CAD 的诊断。
Zotero 插件