https://doi.org/10.1007/s00392-024-02526-y
1Bosch Health Campus Department of Cardiology and Angiology Stuttgart, Deutschland; 2Bosch Health Campus Department of Medical Informatics Stuttgart, Deutschland
Background: For many years, visual assessment has been the mainstay of detecting obstructive coronary artery disease by stress perfusion cardiovascular magnetic resonance (S-CMR). Recently, fully automated quantitative assessment of myocardial blood flow (MBF) has been introduced. The value of MBF quantification in patients with coronary chronic total occlusion (CTO) is currently unknown.
Objectives: To investigate the diagnostic performance of CMR-derived fully automated quantitative MBF assessment in patients with CTO.
Methods: Consecutive patients who underwent S-CMR as well as invasive coronary angiography at our institution between 02/2023 and 01/2024 were included in this study. S-CMR perfusion imaging was assessed visually as well as quantitatively based on fully automated inline MBF quantification. Stenosis severity was assessed angiographically and >70% was considered severe stenosis.
Results: Eighty-two patients (age 67.8(60.0-76.8) years, 79.3% male) were included in this analysis. Patients were stratified according to severity of coronary artery disease (non-obstructed coronary arteries <50%, n=20; severe stenosis >70%, n=35; CTO, n=27). Stress myocardial blood flow (SMBF) and myocardial perfusion reserve (MPR) were significantly reduced in patients with CTO compared to those with severe stenosis and non-obstructed coronary arteries, respectively (Segmental SMBF: 1.48 (1.31-1.69) vs. 1.77 (1.52-2.05) vs. 2.15 (1.84-2.43) ml/g/min, p<0.001; Segmental MPR: 1.82 (1.56-2.55) vs. 2.38 (1.73-2.82) vs. 2.91 (2.01-3.18), p=0.003; Territorial SMBF: 1.15 (0.90-1.31) vs. 1.51 (1.29-1.76) vs.1.92 (1.63-2.31), p<0.001; Territorial MPR: 1.58 (1.26-2.07) vs. 2.24 (1.66-2.89) vs. 3.16 (2.46-3.72), p<0.001). Segmental SMBF <0.93 ml/g/min differentiated CTO from severe stenosis with high accuracy (AUC 0.826 (0.724-0.929)). Moreover, combined visual and quantitative perfusion assessment provided higher sensitivity in detecting additional severe stenosis in patients with CTO compared to visual assessment alone (100% vs. 63%).
Conclusions: Addition of fully automated MBF quantification to clinical routine visual S-CMR reading facilitates non-invasive differentiation between CTO and severe stenosis and provides higher sensitivity regarding true ischemic burden in patients with CTO and multi-vessel disease, thereby aiding clinical decision making.