Key result
3D-CMR perfusion yields comparable diagnostic accuracy for CAD regardless of ejection fraction.
Why the study?
The accuracy of 3D cardiovascular magnetic resonance perfusion imaging for detecting coronary artery disease in patients with reduced ejection fraction was not well established.
Case-Control (n=172)
Yes
Absolute Event Rate: 79.1% vs 83.7%
p-value: p=0.25
Supports 3D CMR perfusion for CAD detection in reduced EF despite lower specificity; leaves open prospective validation before routine use.
Background To assess the accuracy of 3D cardiovascular magnetic resonance (CMR) perfusion imaging for the detection of coronary artery disease (CAD) against fractional flow reserve (FFR) and quantitative coronary angiography (QCA) in patients with reduced ejection fraction (EF). Methods Out of 447 patients who underwent 3D CMR perfusion imaging (at 1.5 and 3.0 T under adenosine stress and at rest) at 5 European centers, 86 cases with an EF ≤50% were identified (mean age 64 ± 11 yrs, 80% male). Significant CAD was defined as a FFR value <0.8 and a QCA >50%. 86 individuals matched for age, gender and major cardiovascular risk factors, were chosen as the control group. Results The prevalence of CAD defined by FFR (<0.8) was 59% (EF≤50%) vs. 54% (EF>50%), P = 0.4). In relation to FFR, 3D perfusion imaging yielded a sensitivity of 84.5% (95% CI 76.0–90.4) and specificity of 77.3% (95% CI 66.7–85.3). The sensitivity of perfusion imaging was higher in patients with an EF≤50% (90.2 vs. 78.3%, P = 0.1) whereas specificity showed the reverse (62.9 vs. 90.0%, P = 0.005) The diagnostic accuracy was comparable in both subgroups (AUC 79.1 vs. 83.7%, P = 0.25). According to QCA, the prevalence of CAD was 78 vs. 72% (P = 0.4). Perfusion imaging yielded a sensitivity and specificity of 82.1 vs. 62.9%, P = 0.01 and 79.0 vs. 95.8%, P = 0.09 respectively with a high diagnostic accuracy in both subgroups (AUC 82.0 vs. 80.5%). Conclusion 3D-CMR perfusion imaging yields a high sensitivity and diagnostic accuracy with regards to the detection of significant CAD irrespective of left ventricular (LV) systolic function.
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Oebel et al. (2020) conducted a case-control in Coronary artery disease in patients with reduced ejection fraction (n=172). 3D cardiovascular magnetic resonance (CMR) perfusion imaging vs. Patients with preserved ejection fraction (EF >50%) was evaluated on Diagnostic accuracy (AUC) for detection of significant CAD defined by FFR <0.8 (p=0.25). 3D-CMR perfusion imaging had comparable diagnostic accuracy for detecting significant CAD in patients with reduced versus preserved ejection fraction (AUC 79.1% vs 83.7%, P=0.25).
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