Multi-center study of whole-heart dynamic 3-dimensional cardiac magnetic resonance perfusion imaging for the detection of coronary artery disease – analysis of diagnostic performance in women
Sandra Hamada1, Alexander Gotschy2,3, Lukas Wissmann3, Sebastian Kozerke3, Cosima Jahnke4, Ingo Paetsch4, Rolf Gebker5, Nikolaus Marx6, Hatem Alkadhi1, and Manka Robert1,7

1Institue of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland, 2Department and Policlinic of Internal Medicine, University Hospital Zurich, Zurich, Switzerland, 3Institue for Biomecical Engineering, University and ETH Zurich, Zurich, Switzerland, 4University Heart Center Leipzig, Leipzig, Germany, 5German Heart Institute Berlin, Berlin, Germany, 6Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany, 7Department of Cardiology, University Heart Center, Universitiy Hospital Zurich, Zurich, Switzerland

Synopsis

Coronary heart disease accounts for a large amount of morbidity and mortality in women. To contribute to evidence for non-invasive testing in women, this study compares diagnostic performance of whole heart dynamic 3D myocardial first-pass perfusion stress imaging in female and male with findings in coronary angiography. 61 female and 139 male with suspected and known coronary artery disease were enrolled and a whole heart dynamic 3D-CMR first-pass perfusion imaging was performed at rest and at stress. Whole heart dynamic 3D-CMR perfusion imaging shows high sensitivity, specificity and diagnostic accuracy in women and men and therefore seems to be a suitable testing tool for myocardial ischemia in women and men.

Background

Coronary heart disease accounts for a large amount of morbidity and mortality in women [1, 2]. Due to differences in symptoms and pathophysiology in myocardial ischemia, diagnostic and therapeutic strategies are underused and therefore cause adverse outcome in women [3]. To contribute to evidence in non-invasive testing for ischemic heart disease in women, this study compares diagnostic performance of whole heart dynamic 3D myocardial first-pass perfusion stress imaging [4] in female and male patients with findings in coronary angiography (CA) using quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as reference.

Methods

200 patients with suspected or known coronary artery disease (CAD) were enrolled in 5 European centers. Each patient registered for CA was sent to cardiac magnetic resonance (CMR) imaging before CA. Whole heart dynamic 3D CMR first-pass perfusion imaging was performed at rest and at stress using adenosine as stressor [5]. All analyses were performed by experienced investigators blinded to all clinical data.

Results

61 women and 139 men were included and successfully examined (mean age women 63±11years, mean age men 63±11years). The prevalence of CAD defined by FFR (<0.8) in the present study was 44.3% in female and 67.7% in male. Sensitivity and specificity of 3D first-pass perfusion CMR were 83% (95% CI: 64.2-94.1) and 91% (95%CI: 75.0-97.9) in the female study population and 79% (95%CI: 69.1-86.5) and 80% (95%CI: 65.4-90.4) in the male study population relative to the QCA reference. Sensitivity and specificity were 93% (95%CI: 75.7-98.9) and 94% (95%CI: 80.3-99.1) in the female study population and 83% (95%CI: 73.8-89.9) and 89% (95%CI: 75.9-96.3) in the male study population when using FFR as the reference. Diagnostic accuracy in the female group was 93% (95%CI: 84.9-98.2) and 86% (95%CI: 79.0-91.2) in the male group.

Conclusion

Whole heart dynamic 3D CMR first-pass perfusion imaging has a high diagnostic accuracy for the detection of significant CAD irrespective of gender and is therefore a suitable non-invasive testing tool to detect myocardial ischemia in women and men.

Acknowledgements

No acknowledgement found.

References

[1] Townsend N et al., European Heart Journal (2015). [2] Mozaffarian D et al., Circulation (2015). [3] Mosca L et al., Circulation (2011). [4] Vitanis V. et al., Magnetic Resonance in Medicine (2011). [5] Manka R et al., JACC (2011).


Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
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