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

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

doi:10.1016/j.jcmg.2024.07.023

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

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

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

5 Citations (Scopus)

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.

Original language	English
Journal	JACC: Cardiovascular Imaging
Volume	17
Issue	12
Pages (from-to)	1428-1441
Number of pages	14
ISSN	1936-878X
DOIs	https://doi.org/10.1016/j.jcmg.2024.07.023
Publication status	Published - Dec 2024

Keywords

obstructive coronary artery disease
quantitative perfusion
stress cardiovascular magnetic resonance

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10.1016/j.jcmg.2024.07.023Licence: CC BY-NC-ND

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Wang, S., Kim, P., Wang, H., Ng, M. Y., Arai, A. E., Singh, A., Mushtaq, S., Sin, T. H., Tada, Y., Hillier, E., Jin, R., Mariager, C. Ø., Salerno, M., Pontone, G., Urmeneta Ulloa, J., Saeed, I. M., Patel, H., Goh, V., Madsen, S., ... Patel, A. R. (2024). Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease. JACC: Cardiovascular Imaging, 17(12), 1428-1441. https://doi.org/10.1016/j.jcmg.2024.07.023

@article{f55c89c352234efcb1c78af6c6ad0eea,

title = "Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease",

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.",

keywords = "obstructive coronary artery disease, quantitative perfusion, stress cardiovascular magnetic resonance",

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

year = "2024",

month = dec,

doi = "10.1016/j.jcmg.2024.07.023",

language = "English",

volume = "17",

pages = "1428--1441",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "12",

}

Wang, S, Kim, P, Wang, H, Ng, MY, Arai, AE, Singh, A, Mushtaq, S, Sin, TH, Tada, Y, Hillier, E, Jin, R, Mariager, CØ, Salerno, M, Pontone, G, Urmeneta Ulloa, J, Saeed, IM, Patel, H, Goh, V, Madsen, S, Kim, WY, Singram Krishnam, M, Martínez de Vega, V, Maceira, AM, Monmeneu, JV, Pazhenkottil, AP, Amir-Khalili, A, Benovoy, M, Friedrich, S, Janich, MA, Friedrich, MG & Patel, AR 2024, 'Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease', JACC: Cardiovascular Imaging, vol. 17, no. 12, pp. 1428-1441. https://doi.org/10.1016/j.jcmg.2024.07.023

Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease. / Wang, Shuo; Kim, Paul; Wang, Haonan et al.
In: JACC: Cardiovascular Imaging, Vol. 17, No. 12, 12.2024, p. 1428-1441.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease

AU - Wang, Shuo

AU - Kim, Paul

AU - Wang, Haonan

AU - Ng, Ming Yen

AU - Arai, Andrew E.

AU - Singh, Amita

AU - Mushtaq, Saima

AU - Sin, Tsun Hei

AU - Tada, Yuko

AU - Hillier, Elizabeth

AU - Jin, Ruyun

AU - Mariager, Christian Østergaard

AU - Salerno, Michael

AU - Pontone, Gianluca

AU - Urmeneta Ulloa, Javier

AU - Saeed, Ibrahim M.

AU - Patel, Hena

AU - Goh, Victor

AU - Madsen, Simon

AU - Kim, Won Yong

AU - Singram Krishnam, Mayil

AU - Martínez de Vega, Vicente

AU - Maceira, Alicia M.

AU - Monmeneu, Jose V.

AU - Pazhenkottil, Aju P.

AU - Amir-Khalili, Alborz

AU - Benovoy, Mitchel

AU - Friedrich, Silke

AU - Janich, Martin A.

AU - Friedrich, Matthias G.

AU - Patel, Amit R.

PY - 2024/12

Y1 - 2024/12

N2 - 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.

AB - 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.

KW - obstructive coronary artery disease

KW - quantitative perfusion

KW - stress cardiovascular magnetic resonance

UR - http://www.scopus.com/inward/record.url?scp=85205452758&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2024.07.023

DO - 10.1016/j.jcmg.2024.07.023

M3 - Journal article

C2 - 39297850

AN - SCOPUS:85205452758

SN - 1936-878X

VL - 17

SP - 1428

EP - 1441

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 12

ER -

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

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