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.

中文翻译：

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使用负荷心脏磁共振进行心肌血流定量可改善冠状动脉疾病的检测。


背景技术使用应激心血管磁共振（CMR）的心肌血流量（MBF）和心肌灌注储备（MPR）已被证明可以识别心外膜冠状动脉疾病。然而，定量灌注和传统定性评估（QA）之间的比较分析仍然有限。目的 这项多中心研究的目的是检验以下假设：定量应激 MBF (sMBF) 和 MPR 分析可以识别阻塞性冠状动脉疾病 (obCAD)，其性能与由经验丰富的医生进行的应激 CMR 质量保证相当。方法 分析包括 127 名接受压力 CMR 的个体（平均年龄 62 ± 16 岁，84 名男性 [67%]）。 obCAD 定义为左冠状动脉主干狭窄≥50%，或主要血管狭窄≥70%。每个患者、冠状动脉区域和心肌段被分类为有 obCAD 或无 obCAD (noCAD)。计算了整体、每个冠状动脉区域以及节段的 MBF 和 MPR 值。 QA 由 4 名 CMR 专家执行。结果 在患者层面，obCAD 受试者的总体 sMBF 和 MPR 显着低于 noCAD 受试者，sMBF 中值为 1.5 mL/g/min（Q1-Q3：1.2-1.8 mL/g/min） 2.4 mL/g/min (Q1-Q3: 2.1-2.7 mL/g/min) (P < 0.001)，MPR 中值为 1.3 (Q1-Q3: 1.0-1.6) vs 2.1 (Q1-Q3: 1.6) -2.7) (P< 0.001)。在冠状动脉水平，与 noCAD 血管相比，obCAD 血管的 sMBF 和 MPR 也显着降低。全球 sMBF 和 MPR 的曲线下面积 (AUC) 分别为 0.90 (95% CI: 0.84-0.96) 和 0.86 (95% CI: 0.80-0.93)。 4 名医生的 QA 的 AUC 范围在 0.69 到 0.88 之间。全局 sMBF 和 MPR 的 AUC 显着优于 QA 的平均 AUC。 结论 这项研究表明，使用双序列应力 CMR 的 sMBF 和 MPR 可以比经验丰富的 CMR 读者的定性分析更准确地识别 obCAD。