Author + information
- Henk Everaars, MDa,∗,
- Nina W. van der Hoeven, MDa,∗,
- Gladys N. Janssens, MDa,
- Maarten A. van Leeuwen, MDe,
- Ramon B. van Loon, MD, PhDa,
- Stefan P. Schumacher, MDa,
- Ahmet Demirkiran, MDa,
- Mark B.M. Hofman, PhDc,
- Rob J. van der Geest, PhDd,
- Peter M. van de Ven, PhDb,
- Marco J. Götte, MD, PhDa,
- Albert C. van Rossum, MD, PhDa,
- Niels van Royen, MD, PhDa,f and
- Robin Nijveldt, MD, PhDa,f,∗ ()
- aDepartment of Cardiology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
- bDepartment of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- cDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- dDepartment of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- eDepartment of Cardiology, Isala Clinics, Zwolle, the Netherlands
- fDepartment of Cardiology, Radboud University Medical Centers, Nijmegen, the Netherlands
- ↵∗Address for correspondence:
Dr. Robin Nijveldt, Amsterdam University Medical Center, location VUmc, Department of Cardiology, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
Objectives This study sought to determine the agreement between cardiac magnetic resonance (CMR) imaging and invasive measurements of fractional flow reserve (FFR) in the evaluation of nonculprit lesions after ST-segment elevation myocardial infarction (STEMI). In addition, we investigated whether fully quantitative analysis of myocardial perfusion is superior to semiquantitative and visual analysis.
Background The agreement between CMR and FFR in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease is unknown.
Methods Seventy-seven patients with STEMI with at least 1 intermediate (diameter stenosis 50% to 90%) nonculprit lesion underwent CMR and invasive coronary angiography in conjunction with FFR measurements at 1 month after primary intervention. The imaging protocol included stress and rest perfusion, cine imaging, and late gadolinium enhancement. Fully quantitative, semiquantitative, and visual analysis of myocardial perfusion were compared against a reference of FFR. Hemodynamically obstructive was defined as FFR ≤0.80.
Results Hemodynamically obstructive nonculprit lesions were present in 31 (40%) patients. Visual analysis displayed an area under the curve (AUC) of 0.74 (95% confidence interval [CI]: 0.62 to 0.83), with a sensitivity of 73% and a specificity of 70%. For semiquantitative analysis, the relative upslope of the stress signal intensity time curve and the relative upslope derived myocardial flow reserve had respective AUCs of 0.66 (95% CI: 0.54 to 0.77) and 0.71 (95% CI: 0.59 to 0.81). Fully quantitative analysis did not augment diagnostic performance (all p > 0.05). Stress myocardial blood flow displayed an AUC of 0.76 (95% CI: 0.64 to 0.85), with a sensitivity of 69% and a specificity of 77%. Similarly, MFR displayed an AUC of 0.82 (95% CI: 0.71 to 0.90), with a sensitivity of 82% and a specificity of 71%.
Conclusions CMR and FFR have moderate-good agreement in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease. Fully quantitative, semiquantitative, and visual analysis yield similar diagnostic performance.
- acute myocardial infarction
- cardiac magnetic resonance
- fractional flow reserve
- non-culprit lesions
- quantitative myocardial perfusion
↵∗ Drs. Everaars and van der Hoeven contributed equally to this manuscript.
This is a substudy of the REDUCE-MVI trial, which was initiated by the Amsterdam UMC, Amsterdam, the Netherlands, with financial support from AstraZeneca through an unrestricted research grant. In addition, the study was financed by the Ministry of Economic Affairs of the Netherlands by means of a PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships. The funding sources did not have any role in the study design; collection, analysis, or interpretation of data; preparation of the manuscript; or decision to submit it for publication. Dr. van Royen reports research grants from AstraZeneca, Abbott, Philips, Biotronik, and Top Sector Life Sciences & Health during the conduct of the study. Dr. van Leeuwen has received research grants from AstraZeneca. Dr. Nijveldt has received research grants from Philips and Biotronik; and financial support from the Netherlands Organization for Health Research and Development (grant 9071544). Dr. Demirkiran has received a research grant from the postdoctoral international research fellowship program of the Scientific and Technological Research Council of Turkey (ref: 53325897-115.02-170549). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2019.
- Accepted July 10, 2019.
- 2019 American College of Cardiology Foundation
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