Myocardial Perfusion after Angioplasty in Patients Suspected of Having Single-Vessel Coronary Artery Disease: Improvement Detected at Rest-Stress First-Pass Perfusion MR Imaging—Initial Experience

Q: What are the key findings of this study?

Successful percutaneous coronary intervention significantly improved the myocardial perfusion reserve index in the stenosed vessel area from 1.04 at baseline to 2.18 several days afterward (P<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Single-vessel coronary artery disease (n=18). Intervention: Percutaneous coronary intervention (PTCA alone or with stent placement) vs. Baseline (before intervention). Primary outcome: Myocardial perfusion reserve index (MPRI) in the area of the stenosed vessel (p=< .001).

Q: What does this research mean for the field?

Successful percutaneous coronary intervention significantly improves the myocardial perfusion reserve index in the stenosed vessel territory as detected by rest-stress SSFP perfusion MR imaging. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To prospectively assess myocardial perfusion changes before and after successful coronary intervention in patients with suspected single-vessel coronary artery disease using an SSFP perfusion MR imaging sequence.

Michael Fenchel; Andreas Franow; Norbert I. Stauder; Ulrich Krämer; Uwe Helber; Claus D. Claussen; Stephan Miller

doi:10.1148/radiol.2371041026

October 1, 2005Radiology

Myocardial Perfusion after Angioplasty in Patients Suspected of Having Single-Vessel Coronary Artery Disease: Improvement Detected at Rest-Stress First-Pass Perfusion MR Imaging—Initial Experience

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Key result

Successful PCI linked to a ~2.1-fold improvement in myocardial perfusion reserve index post-procedure.

P<.001
n=18

Key Points

To prospectively assess myocardial perfusion changes before and after successful coronary intervention in patients with suspected single-vessel coronary artery disease using an SSFP perfusion MR imaging sequence.
Eighteen patients with coronary artery disease (mean age, 58.6 ± 13.6 years) underwent rest-stress first-pass perfusion MRI at 1.5 T using a saturation-recovery SSFP sequence with gadopentetate dimeglumine contrast.
Scans were conducted before intervention (n = 18), several days after (n = 18), and at 8-month follow-up (n = 10); interventions included PTCA alone (n = 9) or PTCA with stent placement (n = 9).
Myocardial perfusion reserve index (MPRI) was calculated by dividing stress perfusion values by rest values, comparing affected areas to remote myocardium.
In the stenosed vessel territory, MPRI significantly increased from 1.04 ± 0.24 before treatment to 2.18 ± 0.57 several days post-intervention (P < .001), approaching remote myocardium levels (2.42 ± 0.44).
Patients receiving stents showed a 156% MPRI increase from 0.99 ± 0.20 to 2.53 ± 0.53 (P < .001), while those undergoing PTCA alone showed a 72% increase from 1.08 ± 0.27 to 1.87 ± 0.39 (P < .001).
At 8-month follow-up in asymptomatic patients, MPRI remained stable at 2.14 ± 0.37 in the treated territory compared to 2.29 ± 0.47 in remote areas (P = .06).

Study Design

Type

Observational (n=18)

PICO

P

Population

18 patients (mean age 58.6) with suspected single-vessel coronary artery disease evaluated with rest-stress perfusion MR imaging before and after percutaneous coronary intervention.

I

Intervention / Comparator

Percutaneous coronary intervention (PTCA alone or with stent placement) vs Baseline (before intervention)

O

Primary Outcome

Myocardial perfusion reserve index (MPRI) in the area of the stenosed vessel, p=< .001

Main Result

Absolute Event Rate: 2.18% vs 1.04%

p-value: p=< .001

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Implication

Demonstrates significant improvement in myocardial perfusion reserve after coronary intervention, indicating successful restoration of cardiac blood flow.

Abstract

PURPOSE: To prospectively assess myocardial perfusion before and after successful intervention in patients suspected of having single-vessel coronary artery disease by using a steady-state free precession (SSFP) perfusion magnetic resonance (MR) imaging sequence. MATERIALS AND METHODS: Local ethics committee approval and informed consent were obtained. Rest-stress perfusion MR imaging studies were performed in 18 patients with coronary artery disease (12 men, six women; mean age, 58.6 years +/- 13.6 [standard deviation]; range, 30-79 years) at 1.5 T with a multisection saturation-recovery SSFP sequence and 0.025 mmol gadopentetate dimeglumine per kilogram of body weight. MR studies were performed before (n = 18), several days after (n = 18), and 8 months after (n = 10) coronary intervention. Nine patients underwent percutaneous transluminal coronary angioplasty (PTCA) alone, and nine patients underwent PTCA with stent placement. Myocardial perfusion reserve index (MPRI) was calculated by dividing results of myocardial perfusion at maximal vasodilation by results at rest. The standard for myocardial perfusion was technetium 99m tetrofosmin single photon emission computed tomography. Statistical significance was tested with univariate variance analysis and Student t tests. RESULTS: In the area of the stenosed vessel, MPRI was 1.04 +/- 0.24 before treatment and 2.18 +/- 0.57 several days afterward (P < .001). In remote areas, MPRI was 2.42 +/- 0.44. In the stent group, MPRI increased by 156%, from 0.99 +/- 0.20 before stent placement to 2.53 +/- 0.53 after (P < .001). Similarly, in the PTCA only group, MPRI increased by 72%, from 1.08 +/- 0.27 before PTCA to 1.87 +/- 0.39 after (P < .001). At follow-up in patients without recurring chest pain, MPRI was 2.14 +/- 0.37 in the area of the treated artery and 2.29 +/- 0.47 in remote areas (P = .06). CONCLUSION: The MPRI, derived from rest-stress examinations, can provide information on success of interventional procedures in stenosed coronary arteries.

Discussion

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Cite This Study

Fenchel et al. (2005) conducted an observational in Single-vessel coronary artery disease (n=18). Percutaneous coronary intervention (PTCA alone or with stent placement) vs. Baseline (before intervention) was evaluated on Myocardial perfusion reserve index (MPRI) in the area of the stenosed vessel (p=< .001). Successful percutaneous coronary intervention significantly improved the myocardial perfusion reserve index in the stenosed vessel area from 1.04 at baseline to 2.18 several days afterward (P<0.001).

synapsesocial.com/papers/6a6f933435aa2c282ce0ecd3 https://doi.org/10.1148/radiol.2371041026

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Myocardial Perfusion after Angioplasty in Patients Suspected of Having Single-Vessel Coronary Artery Disease: Improvement Detected at Rest-Stress First-Pass Perfusion MR Imaging—Initial Experience

Key Points

Study Design

PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Myocardial Perfusion after Angioplasty in Patients Suspected of Having Single-Vessel Coronary Artery Disease: Improvement Detected at Rest-Stress First-Pass Perfusion MR Imaging—Initial Experience

Key Points

Study Design

PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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