- Oral presentation
- Open Access
Transmural perfusion gradient analysis by high-resolution MR versus fractional flow reserve for the assessment of coronary artery stenosis
© Chiribiri et al; licensee BioMed Central Ltd. 2012
- Published: 1 February 2012
- Cardiovascular Magnetic Resonance
- Fractional Flow Reserve
- Significant Coronary Artery Disease
- Myocardial Perfusion Reserve
- Perfusion Cardiovascular Magnetic Resonance
We present the results of transmural perfusion gradient (TPG) analysis (a novel method to evaluate the presence of subendocardial ischemia) versus fractional flow reserve (FFR) for the detection of hemodynamically significant coronary artery disease (CAD).
The subendocardial layer of the left ventricle is affected earlier and more severely by ischemia as a consequence of the interaction between coronary microvasculature and cardiac contraction. The identification of subendocardial ischemia is thus considered a sensitive and specific endpoint for the diagnosis of CAD. TPG due to subendocardial ischemia can be visualised on high resolution perfusion cardiovascular magnetic resonance (CMR) images and their presence can be specifically assessed by the gradientogram plot. This study tests the hypothesis that transmural perfusion gradients by adenosine stress CMR predict hemodynamically significant CAD as assessed by FFR and compares TPG with perfusion quantitative analysis.
63 patients (49 male, 60±9 years) with known or suspected CAD underwent high-resolution (1.2 x 1.2 mm in plane) adenosine stress perfusion CMR at 3.0T. FFR was measured in all vessels with >50% severity stenosis. FFR<0.80 was considered hemodynamically significant. TPG were measured by the gradientogram plot and data analysed based on different thresholds of transmural perfusion redistribution (of 5%, 10%, 15% and 20%). Myocardial perfusion reserve (MPR) was assessed by Fermi deconvolution.
Transmural perfusion analysis details in Group 1 for thresholds of 5%, 10%, 15% and 20%.
Positive Predictive Value
Negative Predictive Value
Area under the ROC curve
On ROC analysis performed on Group 1, a MPR cut-off of 1.55 provided optimal diagnostic accuracy to detect myocardial ischemia (area under the ROC curve 0.81). When the same MPR cut-off was applied to the quantitative analysis of Group 2, it resulted in a sensitivity of 0.70 and a specificity of 0.91. On ROC analysis, the AUC was 0.82. Gradient analysis was more accurate than myocardial perfusion reserve (p=0.001).
The detection of transmural perfusion gradients by high-resolution CMR allows an accurate diagnosis of hemodynamically significant CAD as compared to FFR and in this study was more accurate than myocardial perfusion reserve.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.