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- Open Access
Assessment of semi-quantitative parameters for visual interpretation of stress-perfusion CMR in obstructive coronary artery disease
© Jensen et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Invasive Coronary Angiography
- Obstructive Coronary Artery Disease
- Adenosine Stress
- Transmural Extent
- Rest Perfusion
Adenosine stress CMR with visual interpretation is increasingly used in the evaluation of patients with CAD. The definition of a stress perfusion defect is inconsistent in the literature regarding i) the duration from contrast arrival, ii) persistence relative to a remote segment, iii) transmural extent, and iv) reversibility on rest perfusion.
In this study we sought to test several semi-quantitative parameters assessed by rapid visual analysis, and determine their utility to identify stress-perfusion defects from obstructive CAD.
25 patients (61±14 years, 44% male) with known CAD and ≥70% stenosis on invasive coronary angiography (CA) were studied (60% single-vessel, 40% two-vessel disease). All patients underwent CMR within 2 months of CA, typically, four short-axis images were obtained each heartbeat during adenosine stress and rest. Patients with infarction, revascularization, and cardiomyopathy were excluded.
Stress and rest perfusion images were analyzed visually using a 16-segment model. The number of frames from left-ventricular (LV) cavity peak contrast to myocardial signal homogeneity (MET) within each segment was assessed (n=400 segments). We scored the transmural extent (in quartiles) of any segmental hypoenhancement persiting ≥1 frame beyond the first homogenous segment in the same slice. CA was reviewed to determine for each segment, whether they are subtended by a stenotic coronary artery ("ischemic" vs "non-ischemic" segments).
Stress-perfusion defects in obstructive CAD tend to be >25% in transmural extent, persist for >4 frames, and have no corresponding rest perfusion defects.
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.