使用负荷心脏磁共振成像进行心肌血流定量可改善冠状动脉疾病的检测。

Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease.

作者信息

Wang Shuo, Kim Paul, Wang Haonan, Ng Ming-Yen, Arai Andrew E, Singh Amita, Mushtaq Saima, Sin Tsun Hei, Tada Yuko, Hillier Elizabeth, Jin Ruyun, Mariager Christian Østergaard, Salerno Michael, Pontone Gianluca, Urmeneta Ulloa Javier, Saeed Ibrahim M, Patel Hena, Goh Victor, Madsen Simon, Kim Won Yong, Singram Krishnam Mayil, Martínez de Vega Vicente, Maceira Alicia M, Monmeneu Jose V, Pazhenkottil Aju P, Amir-Khalili Alborz, Benovoy Mitchel, Friedrich Silke, Janich Martin A, Friedrich Matthias G, Patel Amit R

机构信息

Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.

Division of Medicine, University of California-San Diego, San Diego, California, USA.

出版信息

JACC Cardiovasc Imaging. 2024 Dec;17(12):1428-1441. doi: 10.1016/j.jcmg.2024.07.023. Epub 2024 Sep 18.

DOI:10.1016/j.jcmg.2024.07.023

PMID:39297850

Abstract

BACKGROUND

Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) using stress cardiovascular magnetic resonance (CMR) have been shown to identify epicardial coronary artery disease. However, comparative analysis between quantitative perfusion and conventional qualitative assessment (QA) remains limited.

OBJECTIVES

The aim of this multicenter study was to test the hypothesis that quantitative stress MBF (sMBF) and MPR analysis can identify obstructive coronary artery disease (obCAD) with comparable performance as QA of stress CMR performed by experienced physicians in interpretation.

METHODS

The analysis included 127 individuals (mean age 62 ± 16 years, 84 men [67%]) who underwent stress CMR. obCAD was defined as the presence of stenosis ≥50% in the left main coronary artery or ≥70% in a major vessel. Each patient, coronary territory, and myocardial segment was categorized as having either obCAD or no obCAD (noCAD). Global, per coronary territory, and segmental MBF and MPR values were calculated. QA was performed by 4 CMR experts.

RESULTS

At the patient level, global sMBF and MPR were significantly lower in subjects with obCAD than in those with noCAD, with median values of sMBF of 1.5 mL/g/min (Q1-Q3: 1.2-1.8 mL/g/min) vs 2.4 mL/g/min (Q1-Q3: 2.1-2.7 mL/g/min) (P < 0.001) and median values of MPR of 1.3 (Q1-Q3: 1.0-1.6) vs 2.1 (Q1-Q3: 1.6-2.7) (P < 0.001). At the coronary artery level, sMBF and MPR were also significantly lower in vessels with obCAD compared with those with noCAD. Global sMBF and MPR had areas under the curve (AUCs) of 0.90 (95% CI: 0.84-0.96) and 0.86 (95% CI: 0.80-0.93). The AUCs for QA by 4 physicians ranged between 0.69 and 0.88. The AUC for global sMBF and MPR was significantly better than the average AUC for QA.

CONCLUSIONS

This study demonstrates that sMBF and MPR using dual-sequence stress CMR can identify obCAD more accurately than qualitative analysis by experienced CMR readers.

摘要

背景

利用应力心血管磁共振成像（CMR）测量的心肌血流量（MBF）和心肌灌注储备（MPR）已被证明可用于识别心外膜冠状动脉疾病。然而，定量灌注与传统定性评估（QA）之间的比较分析仍然有限。

目的

这项多中心研究的目的是检验以下假设：定量应力MBF（sMBF）和MPR分析在识别阻塞性冠状动脉疾病（obCAD）方面的表现与经验丰富的医生进行的应力CMR定性分析相当。

方法

分析纳入了127例接受应力CMR检查的个体（平均年龄62±16岁，84例男性[67%]）。obCAD定义为左主干冠状动脉狭窄≥50%或主要血管狭窄≥70%。将每位患者、冠状动脉区域和心肌节段分类为患有obCAD或无obCAD（无CAD）。计算整体、每个冠状动脉区域和节段的MBF和MPR值。QA由4名CMR专家进行。

结果

在患者层面，obCAD患者的整体sMBF和MPR显著低于无CAD患者，sMBF的中位数为1.5 mL/g/min（四分位间距：1.2 - 1.8 mL/g/min），而无CAD患者为2.4 mL/g/min（四分位间距：2.1 - 2.7 mL/g/min）（P < 0.001），MPR的中位数为1.3（四分位间距：1.0 - 1.6），而无CAD患者为2.1（四分位间距：1.6 - 2.7）（P < 0.001）。在冠状动脉层面，与无CAD的血管相比，obCAD血管的sMBF和MPR也显著降低。整体sMBF和MPR的曲线下面积（AUC）分别为0.90（95%CI：0.84 - 0.96）和0.86（95%CI：0.80 - 0.93）。4名医生进行QA的AUC在0.69至0.88之间。整体sMBF和MPR的AUC显著优于QA的平均AUC。