부산대학교 도서관

Background: Ischemic heart disease (IHD) as a consequence of untreated Coronary Arterial Disease (CAD) is one of the top three causes of mortality and the most common cause of morbidity in developed countries. In treatment of stable CAD, recognition of obstructive lesions that are haemodynamically significant is very important as this helps in decision-making to select patients who will benefit from revascularization procedures measured in terms of symptomatic relief, mortality and major adverse cardiac events (MACE). Although cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) is considered a novel non invasive modality for detection of functionally significant obstructive CAD, its diagnostic power is variable from one study to another.Methods: Medline, PUBMED and Cochrane databases were systematically searched (English articles published before January 2013) for studies that measure the accuracy CMR-MPI in detection of haemodynamically significant coronary artery Endo-luminal stenosis compared to invasive pressure guide-wire fractional flow reserve (FFR). All the studies were closely assessed by QUADAS-2 (Quality Assessment of diagnostic Accuracy studies). Using Meta-Disc software, pooled diagnostic odd ratios (DOR), sensitivity, specificity and positive likelihood ratio were calculated. Summary of receiver operator characteristics (SROCs) curves were also constructed to calculate areas under the curve (AUCs).Results: 9 prospective crossectional studies involving 568 patients were yielded from screening 14836 titles and abstracts followed by full text references review. Pooled DOR, Sensitivity, specificity and positive likelihood ratio(+LR) for CMR-MPI at 95% confidence interval (CI) were 74.1 (39.4-139.1), 92.9% (87.7% to 96.4%), 89% (81.2% to 94.4%) and +LR of 6.47 (4.63-9.03) on patient bases and 36.9(12.2-109.1), 86.5 %( 81.5% to 90.6%), 91.9 (89.1 to 94.2%) and 10.98(8.73- 13.79) for cut off myocardial perfusion reserve (MPR) of about 1.5 and for FFR <0.75 respectively. SROCs plotted displayed AUCs of 0.932 and 0.970 on the above bases of analysis.Conclusion: CMR perfusion still shows both high sensitivity and specificity in detection of haemodynamically obstructive intra-luminal stenotic lesion in patient with known or suspected CAD. As it is non-invasive and does not expose patients to ionizing radiation it can be used as an alternative to invasive pressure-wire guided FFR to select patient who need revascularisation.