Semi-quantitative Analysis of Adenosine Perfusion Magnetic Resonance Imaging Outperforms Visual Analysis in Identifying Fractional Flow Reserve-Altered Intermediate-grade Coronary Artery Stenosis: A Pilot Study

Abstract PurposeTo evaluate the diagnostic accuracy of semi-quantitative adenosine perfusion magnetic resonance imaging(MRI) to determine fractional flow reserve(FFR)≤0.80 intermediate-grade coronary stenoses as compared to visual analysis.Methods Forty-six patients (mean age 61±9 years;33 males) with 49 intermediate-grade stenoses underwent adenosine perfusion MRI and FFR measurement within 4 months between 2010 and 2013. Retrospective interpretation of all prospectively acquired data was performed. MRI was visually assessed by 2 experienced readers twice with one-year interval, the second time with the knowledge of the diseased artery. All myocardial enhancement maximal upslopes were evaluated distal to the coronary stenosis (=RISK) and in remote myocardium supplied by normal arteries (=REMOTE); stress subendocardial relative myocardial perfusion index (RMPI; RISK/REMOTE upslopes) was assessed in predicting FFR≤0.80 stenoses. Deep learning boosting models including all RISK and REMOTE upslopes were fitted to confirm the added value of accounting for perfusion changes in remote myocardium for FFR prediction. Results The average FFR value was 0.84±0.09 and 15/49 (31%) stenoses were FFR≤0.80. Both readers had moderate accuracy (range: 36/49(73%)-38/49(78%)) in predicting FFR≤0.80 stenoses, even with the knowledge of the stenosis location. At a cutoff value of 0.84, stress subendocardial RMPI had higher accuracy (43/49(88%)) than individual visual readings to predict FFR≤0.80 stenoses. The best FFR prediction using the boosting model occurred when accounting for REMOTE myocardial perfusion parameters, leading to diagnostic accuracy of 44/49(90%) for FFR≤0.80. Conclusion Semi-quantitative adenosine perfusion MRI accounting for stress perfusion in remote myocardium predicts FFR≤0.80 intermediate-grade coronary stenoses with a higher accuracy than individual visual analysis.

Download Full-text

FRACTIONAL FLOW RESERVE CORRELATES WITH BLOOD OXYGEN LEVEL-DEPENDENT (BOLD) MAGNETIC RESONANCE IMAGING IN CORONARY ARTERY DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)61069-9 ◽

2012 ◽

Vol 59 (13) ◽

pp. E1068

Author(s):

Peter Bernhardt ◽

Wolfgang Rottbauer ◽

Jochen Woehrle

Keyword(s):

Magnetic Resonance Imaging ◽

Coronary Artery Disease ◽

Blood Oxygen Level Dependent ◽

Blood Oxygen ◽

Oxygen Level ◽

Resonance Imaging ◽

Fractional Flow ◽

Blood Oxygen Level ◽

Flow Reserve ◽

Artery Disease

Download Full-text

Value of Magnetic Resonance Imaging, Angiography, and Fractional Flow Reserve to Evaluate the Left Main Coronary Artery After Direct Surgical Angioplasty

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2006.09.071 ◽

2007 ◽

Vol 83 (2) ◽

pp. 490-494 ◽

Cited By ~ 2

Author(s):

Cornelis J. Botman ◽

Hans Post ◽

Olaf Penn ◽

Nico Pijls

Keyword(s):

Magnetic Resonance Imaging ◽

Coronary Artery ◽

Magnetic Resonance ◽

Fractional Flow Reserve ◽

Left Main Coronary Artery ◽

Resonance Imaging ◽

Left Main ◽

Fractional Flow ◽

Magnetic Resonance Imaging Angiography ◽

Flow Reserve

Download Full-text

OCT-Derived Plaque Morphology and FFR-Determined Hemodynamic Relevance in Intermediate Coronary Stenoses

Journal of Clinical Medicine ◽

10.3390/jcm10112379 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2379

Author(s):

Mariusz Tomaniak ◽

Dorota Ochijewicz ◽

Łukasz Kołtowski ◽

Adam Rdzanek ◽

Arkadiusz Pietrasik ◽

...

Keyword(s):

Necrotic Core ◽

Plaque Morphology ◽

Lumen Area ◽

Fractional Flow ◽

Intermediate Grade ◽

Fibrous Cap ◽

Flow Reserve ◽

Increased Risk ◽

Minimal Lumen Area ◽

Coronary Stenoses

Background: optical coherence tomography (OCT) might allow identifying lesion features reportedly associated with plaque vulnerability and increased risk of clinical events. Previous studies on correlation between OCT and functional lesion significance indices reported contradictory results, yet integration of complementary information from both modalities is gaining increased interest. The aim of the study was to compare plaque morphology using OCT in hemodynamically relevant vs. non-relevant lesions by fractional flow reserve (FFR). Methods: consecutive patients with intermediate grade coronary stenoses by angiography were evaluated by both FFR and OCT in this single-center study. Stenoses were labeled hemodynamically relevant in case of the FFR ≤ 0.80. Minimal lumen area (MLA), fibrous cap thickness (FCT), minimal cap thickness over the calcium, angle of the calcium, and necrotic core within the lesions were evaluated. Results: a total of 105 patients (124 vessels) were analyzed. Of them, 65 patients were identified with at least one lesion identified as hemodynamically relevant by FFR (72 vessels, 58.1%). Lesions with FFR ≤0.80 presented with lower mean and minimal lumen area (3.46 ± 1.29 vs. 4.65 ± 2.19, p =0.001 and 1.84 ± 0.97 vs. 2.66 ± 1.40, p = 0.001) compared to patients with FFR > 0.80. No differences were found between groups in the mean and minimal FCT, mean, and maximal necrotic core, calcium angle, as well as the overall rate of calcified and lipid plaques. Conclusion: hemodynamic relevance of intermediate grade lesions correlated moderately with the luminal assessment by OCT. No differences were identified in the plaque morphology between relevant and non-relevant coronary stenoses by FFR.

Download Full-text