Abstract
Background Left main stem (LMS) disease occurs in approximately 5% of patients with stable angina. It confers adverse prognosis, with potential for prognostic gain with revascularization. Single-photon emission computed tomography (SPECT) and CMR fail to detect ischemia in 41% and 18% of patients with significant LMS stenosis respectively [1], likely in part because of balanced reduction in coronary perfusion. It is not known whether quantitative assessment of myocardial blood flow (MBF) can improve diagnostic rates. The CE-MARC study prospectively enrolled 752 patients with suspected coronary artery disease, scheduled to undergo CMR, SPECT and X-ray coronary angiography [2]. We assessed the diagnostic performance of visual and quantitative perfusion CMR in CE-MARC patients with LMS disease. Methods All patients from the CE-MARC population with LMS disease ≥50%, or LMS equivalent disease (proximal LAD and proximal LCx ≥70%) on quantitative angiography were studied. A control group (matched for age and gender, excluding LMS or 3-vessel disease) was randomly selected from the CE-MARC population. Visual SPECT and CMR analyses were from the original, blinded read of CE-MARC. Only perfusion components of the CE-MARC CMR and SPECT protocols were analyzed. MBF was calculated offline (PMI v0.4) using the Fermi model from CMR stress perfusion images, with arterial input defined in LV blood pool, and LAD and LCx segments in the mid-LV short axis myocardial slice as tissue response. Results
Highlights
Left main stem (LMS) disease occurs in approximately 5% of patients with stable angina
myocardial blood flow (MBF) was calculated offline (PMI v0.4) using the Fermi model from CMR stress perfusion images, with arterial input defined in LV blood pool, and LAD and LCx segments in the mid-LV short axis myocardial slice as tissue response
47 patients were included in the analysis (22 LMS, 1 LMS equivalent, 24 controls); 1 LMS patient did not have CMR
Summary
Visual and quantitative perfusion analysis in left main stem disease: a CE-MARC substudy. John P Greenwood[1], Ananth Kidambi1*, Neil Maredia[1], Kevin Mohee[1], Steven Sourbron[2], Manish Motwani[1], Akhlaque Uddin[1], David P Ripley[1], Bernhard A Herzog[1], Arshad Zaman[1,2], Catherine J Dickinson[3], Julia Brown[4], Jane Nixon[4], Colin Everett[4], Sven Plein[1]. From 16th Annual SCMR Scientific Sessions San Francisco, CA, USA. From 16th Annual SCMR Scientific Sessions San Francisco, CA, USA. 31 January - 3 February 2013
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
