(Circulation. 2000;101:1379.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Noninvasive Detection of Myocardial Ischemia From Perfusion Reserve Based on Cardiovascular Magnetic Resonance
From the Department of Internal Medicine/Cardiology, German Heart Institute Berlin and Charité, Campus Virchow, Humboldt University, Berlin, Germany.
Correspondence to Eike Nagel, MD, Internal Medicine/Cardiology, German Heart Institute and Charité, Campus Virchow, Humboldt University, Augustenburger Platz 1, D-13353 Berlin, Germany. E-mail eike.nagel{at}dhzb.de
Background—Myocardial perfusion reserve can be noninvasively assessed with cardiovascular MR. In this study, the diagnostic accuracy of this technique for the detection of significant coronary artery stenosis was evaluated.
Methods and Results—In 15 patients with single-vessel
coronary artery disease and 5 patients without significant
coronary artery disease, the signal intensity–time curves of
the first pass of a gadolinium-DTPA bolus injected through a central
vein catheter were evaluated before and after
dipyridamole infusion to validate the technique. A
linear fit was used to determine the upslope, and a cutoff value for
the differentiation between the myocardium supplied by
stenotic and nonstenotic coronary arteries was
defined. The diagnostic accuracy was then examined
prospectively in 34 patients with coronary artery disease and
was compared with coronary angiography. A significant
difference in myocardial perfusion reserve between ischemic and
normal myocardial segments (1.08±0.23 and 2.33±0.41;
P<0.001) was found that resulted in a cutoff value of
1.5 (mean minus 2 SD of normal segments). In the prospective
analysis, sensitivity, specificity, and diagnostic
accuracy for the detection of coronary artery stenosis
(
75%) were 90%, 83%, and 87%, respectively. Interobserver and
intraobserver variabilities for the linear fit were low
(r=0.96 and 0.99).
Conclusions—MR first-pass perfusion measurements yielded a high diagnostic accuracy for the detection of coronary artery disease. Myocardial perfusion reserve can be easily and reproducibly determined by a linear fit of the upslope of the signal intensity–time curves.
Key Words: magnetic resonance imaging • perfusion • coronary disease
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