부산대학교 도서관

Introduction: In patients with stable angina, confirming whether symptoms are due to epicardial coronary artery disease (CAD) or coronary microvascular dysfunction (MVD) remains challenging. Recent advances in fully automated in-line CMR myocardial perfusion mapping now enables quantification of myocardial blood flow (MBF) to be performed rapidly within a clinical workflow. Aims: To assess the performance of perfusion mapping against invasive coronary physiology reference standards for detecting CAD (fractional flow reserve (FFR) < 0.80), MVD (defined by index of microcirculatory resistance (IMR > 25) and the ability to differentiate between the two. Methods: Fifty patients (40 male, mean age 63±8 years) with stable angina and 15 healthy volunteers underwent adenosine stress CMR at 1.5T. MBF and myocardial perfusion reserve (stress/rest MBF) were measured on stress and rest perfusion maps (Panel A). During subsequent angiography, 27 patients had CAD (14 single vessel, 5 two vessel, 8 three vessel disease (3VD)) and 23 had non-obstructed arteries (7 normal IMR, 16 abnormal IMR). A multi-tiered detection strategy was used to objectively classify normal, MVD, 3VD, and 1 or 2 vessel CAD. Results: FFR-positive (epicardial stenosis) areas had significantly lower stress MBF (1.47±0.48ml/g/min) and MPR (1.75±0.60) than FFR-negative IMR-positive (MVD) areas (stress MBF 2.10±0.35ml/g/min, MPR 2.41±0.79) and normal areas (stress MBF 2.47±0.50ml/g/min, MPR 2.94±0.81). Stress MBF < 1.94ml/g/min accurately detected obstructive CAD on a regional basis (AUC 0.90, p<0.001) (Panel B). In subjects without regional perfusion defects, stress MBF >2.28ml/g/min differentiated normal from abnormal (3VD or MVD) subjects (AUC 0.94, p<0.001). Furthermore, stress MBF <1.82ml/g/min was able to accurately discriminate between obstructive 3VD and MVD (AUC 0.94 p<0.001) (Panel C). Conclusions: Myocardial perfusion mapping by CMR is able to accurately detect and differentiate physiologically significant CAD defined by FFR from MVD defined by IMR. [ABSTRACT FROM AUTHOR]