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Systolic versus diastolic myocardial blood flow in patients with suspected coronary artery disease - a cardiovascular magnetic resonance study
© Motwani et al; licensee BioMed Central Ltd. 2012
- Published: 1 February 2012
- Coronary Artery Disease
- Cardiovascular Magnetic Resonance
- Myocardial Blood Flow
- Receiver Operator Characteristic Analysis
- Coronary Artery Disease Patient
This study has shown that in patients with suspected and confirmed CAD, estimates of MBF by perfusion-CMR are significantly higher in diastole than systole during maximal hyperemic stress.
Differences in myocardial blood flow (MBF) between systole and diastole have been reported in healthy volunteers but the impact of cardiac phase on detecting coronary artery disease (CAD) is unknown . This study aimed to compare MBF estimates from cardiovascular magnetic resonance (perfusion-CMR) imaging in systole and diastole in patients with suspected CAD and determine if either phase has greater diagnostic accuracy.
Following invasive coronary angiography, 40 patients (68% men, 64 ± 8 yrs) underwent stress perfusion-CMR (1.5T Philips) acquired at mid-systole and end-diastole simultaneously . Based on angiographic stenosis >70%, patients were grouped as having ‘CAD’ or ‘no CAD’. In patients with CAD, myocardial segments were classified as ‘stenosis-dependent’ (downstream of a significant stenosis) or ‘remote’. For each segment, MBF (Fermi-constrained deconvolution) and myocardial perfusion reserve (MPR) were calculated. The diagnostic accuracy of each phase was determined with receiver operator characteristic analysis.
Estimates of stress MBF and MPR by perfusion-CMR in this study were greater in diastole than systole in normal and CAD patients. Although the diagnostic accuracy of both phases was similar, the MPR cut-off values were different. These observations are particularly important in the emerging field of 3D perfusion-CMR where the acquisition phase may be specifically chosen. Different estimates of MBF and different MPR cut-off values between phases mean a universal standard needs to be agreed for 3D acquisitions.
S.P is funded by a British Heart Foundation fellowship (FS/10/62/28409).
S.P and J.P.G received an unrestricted educational research grant from Philips Healthcare.
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.