Multi-centre study of whole-heart dynamic 3D cardiac magnetic resonance perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve: gender based analysis of diagnostic performance.
- Hamada S Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
- Gotschy A Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
- Wissmann L Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland.
- Paetsch I HELIOS Heart Center Leipzig - University Hospital of Leipzig, Department of Rhythmology, Struempellstrasse 39, Leipzig 04289, Germany.
- Jahnke C HELIOS Heart Center Leipzig - University Hospital of Leipzig, Department of Rhythmology, Struempellstrasse 39, Leipzig 04289, Germany.
- Plein S Multidisciplinary Cardiovascular Research Center & the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS29JT, UK.
- Gebker R German Heart Institute Berlin, Department of Internal Medicine - Cardiology, Augustenburger Platz 1, Berlin 13353, Germany.
- Oebel S Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
- Alkadhi H Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
- Marx N Department of Cardiology, Pneumology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany.
- Lüscher TF Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
- Kozerke S Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland.
- Manka R Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
- 2017-10-07
Published in:
- European heart journal cardiovascular Imaging. - 2017
cardiac magnetic resonance imaging
myocardial ischaemia in women
myocardial perfusion imaging
Adult
Age Factors
Aged
Cohort Studies
Confidence Intervals
Coronary Angiography
Coronary Artery Disease
Female
Fractional Flow Reserve, Myocardial
Humans
Imaging, Three-Dimensional
Internationality
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Perfusion Imaging
Predictive Value of Tests
ROC Curve
Radiographic Image Enhancement
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Sex Factors
English
Aims
Coronary artery disease (CAD) is a leading cause of morbidity and mortality in women and non-invasive testing for CAD in women can be more challenging than in men. This study compared the diagnostic performance of whole-heart dynamic 3D cardiovascular magnetic resonance (CMR) stress perfusion imaging in female and male patients with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as reference tests.
Methods and results
Four hundred sixteen patients with suspected or known CAD were enrolled in five European centres. CMR imaging was performed prior to clinically indicated coronary angiography. QCA was performed in all patients and FFR in 357 of 416 patients. Whole-heart dynamic 3D CMR first-pass perfusion imaging was conducted at rest and during adenosine stress. All CMR analyses were operated by experienced investigators blinded to all clinical data. One hundred nineteen female and 297 male patients were included and successfully examined (mean age 65 ± 11 and 63 ± 11 years, respectively). FFR was performed in 106 female and 251 male patients. Sensitivity and specificity of whole-heart dynamic 3D CMR stress perfusion imaging were 89% (95% CI: 77-96) and 82% (95% CI: 70-90) in the female population and 83% (95% CI: 77-86) and 79% (95% CI: 71-86) in the male population relative to QCA (P = 0.474 and P = 0.83, P-values for comparison between genders). Sensitivity and specificity were 95% (95% CI: 82-99) and 84% (95% CI: 73-92) in the female population and 83% (95% CI: 76-89) and 82% (95% CI: 74-88) in the male population when using FFR as the reference (P = 0.134 and P = 0.936, P-values for comparison between genders). Diagnostic accuracy in females was 92% (95% CI: 85-96) and 86% (95% CI: 81-90) in males when using FFR as the reference. The prevalence of CAD as defined by FFR (<0.8) was 36% in females and 53% in males.
Conclusion
Whole-heart dynamic 3D CMR stress 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 ischaemia in both genders.
Coronary artery disease (CAD) is a leading cause of morbidity and mortality in women and non-invasive testing for CAD in women can be more challenging than in men. This study compared the diagnostic performance of whole-heart dynamic 3D cardiovascular magnetic resonance (CMR) stress perfusion imaging in female and male patients with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as reference tests.
Methods and results
Four hundred sixteen patients with suspected or known CAD were enrolled in five European centres. CMR imaging was performed prior to clinically indicated coronary angiography. QCA was performed in all patients and FFR in 357 of 416 patients. Whole-heart dynamic 3D CMR first-pass perfusion imaging was conducted at rest and during adenosine stress. All CMR analyses were operated by experienced investigators blinded to all clinical data. One hundred nineteen female and 297 male patients were included and successfully examined (mean age 65 ± 11 and 63 ± 11 years, respectively). FFR was performed in 106 female and 251 male patients. Sensitivity and specificity of whole-heart dynamic 3D CMR stress perfusion imaging were 89% (95% CI: 77-96) and 82% (95% CI: 70-90) in the female population and 83% (95% CI: 77-86) and 79% (95% CI: 71-86) in the male population relative to QCA (P = 0.474 and P = 0.83, P-values for comparison between genders). Sensitivity and specificity were 95% (95% CI: 82-99) and 84% (95% CI: 73-92) in the female population and 83% (95% CI: 76-89) and 82% (95% CI: 74-88) in the male population when using FFR as the reference (P = 0.134 and P = 0.936, P-values for comparison between genders). Diagnostic accuracy in females was 92% (95% CI: 85-96) and 86% (95% CI: 81-90) in males when using FFR as the reference. The prevalence of CAD as defined by FFR (<0.8) was 36% in females and 53% in males.
Conclusion
Whole-heart dynamic 3D CMR stress 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 ischaemia in both genders.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/ehjci/jex160
- PMID 28984890
- Persistent URL
- https://folia.unifr.ch/global/documents/223529
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